|
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 |
$74.76 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: Aetna Commercial |
$146.23
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.15
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$109.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.50
|
| Rate for Payer: BCN Commercial |
$202.61
|
| 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: Meridian Medicaid |
$78.50
|
| 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 Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.57
|
| Rate for Payer: Priority Health Medicare |
$109.13
|
| Rate for Payer: Priority Health Narrow Network |
$157.57
|
| Rate for Payer: Priority Health SBD |
$157.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.13
|
| Rate for Payer: UHC Medicare Advantage |
$109.13
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
| 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 |
$2,166.65 |
| Rate for Payer: Aetna American Axle |
$178.10
|
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| 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 |
$219.20
|
| 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 |
$689.36
|
| 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 |
$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 |
$232.90
|
| 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 |
$232.90
|
| 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 |
$178.10
|
| 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 |
$172.62
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.96
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$109.96
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: UMR Bronson Commercial |
$101.38
|
| Rate for Payer: VA VA |
$689.36
|
| 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
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: Aetna Commercial |
$146.23
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.15
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$109.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.50
|
| Rate for Payer: BCN Commercial |
$202.61
|
| 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: Meridian Medicaid |
$78.50
|
| 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 Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.57
|
| Rate for Payer: Priority Health Medicare |
$109.13
|
| Rate for Payer: Priority Health Narrow Network |
$157.57
|
| Rate for Payer: Priority Health SBD |
$157.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.13
|
| Rate for Payer: UHC Medicare Advantage |
$109.13
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
|
|
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 |
$97.34 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$148.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.97
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$233.24
|
| 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: Meridian Medicaid |
$102.21
|
| 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 Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.09
|
| Rate for Payer: Priority Health Medicare |
$142.34
|
| Rate for Payer: Priority Health Narrow Network |
$204.09
|
| Rate for Payer: Priority Health SBD |
$204.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
| 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
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$148.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.97
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$233.24
|
| 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: Meridian Medicaid |
$102.21
|
| 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 Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.09
|
| Rate for Payer: Priority Health Medicare |
$142.34
|
| Rate for Payer: Priority Health Narrow Network |
$204.09
|
| Rate for Payer: Priority Health SBD |
$204.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
| 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 |
$2,166.65 |
| Rate for Payer: Aetna American Axle |
$213.20
|
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| 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 |
$262.40
|
| 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 |
$689.36
|
| 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 |
$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 |
$278.80
|
| 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 |
$278.80
|
| 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 |
$213.20
|
| 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 |
$206.64
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.76
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$142.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: UMR Bronson Commercial |
$121.36
|
| Rate for Payer: VA VA |
$689.36
|
| 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
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$107.14 |
| 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) |
$210.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.58
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS MAPPO |
$157.35
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: BCN Commercial |
$264.65
|
| 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: Meridian Medicaid |
$112.50
|
| 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 Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.41
|
| Rate for Payer: Priority Health Medicare |
$157.35
|
| Rate for Payer: Priority Health Narrow Network |
$224.41
|
| Rate for Payer: Priority Health SBD |
$224.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.35
|
| Rate for Payer: UHC Medicare Advantage |
$157.35
|
| Rate for Payer: UHCCP Medicaid |
$107.14
|
| 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 |
$157.41 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna American Axle |
$302.25
|
| Rate for Payer: Aetna Commercial |
$395.25
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,727.02
|
| Rate for Payer: BCN Commercial |
$1,727.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$372.00
|
| 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 |
$1,587.48
|
| 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 |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.25
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$395.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$292.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.15
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$157.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: UMR Bronson Commercial |
$172.05
|
| Rate for Payer: VA VA |
$1,587.48
|
| 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
|
| Min. Negotiated Rate |
$107.14 |
| 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) |
$210.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.58
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS MAPPO |
$157.35
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: BCN Commercial |
$264.65
|
| 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: Meridian Medicaid |
$112.50
|
| 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 Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.41
|
| Rate for Payer: Priority Health Medicare |
$157.35
|
| Rate for Payer: Priority Health Narrow Network |
$224.41
|
| Rate for Payer: Priority Health SBD |
$224.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.35
|
| Rate for Payer: UHC Medicare Advantage |
$157.35
|
| Rate for Payer: UHCCP Medicaid |
$107.14
|
| 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
|
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 >4.0 CM
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$239.35 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna American Axle |
$427.05
|
| Rate for Payer: Aetna Commercial |
$558.45
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,502.91
|
| Rate for Payer: BCN Commercial |
$2,502.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$525.60
|
| 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 |
$1,587.48
|
| 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 |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$558.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$413.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.28
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$239.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: UMR Bronson Commercial |
$243.09
|
| Rate for Payer: VA VA |
$1,587.48
|
| 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 |
$160.82 |
| 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) |
$318.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.78
|
| Rate for Payer: BCBS Complete |
$168.86
|
| Rate for Payer: BCBS MAPPO |
$238.04
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$375.00
|
| 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: Meridian Medicaid |
$168.86
|
| 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 Choice Medicaid |
$160.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.18
|
| Rate for Payer: Priority Health Medicare |
$238.04
|
| Rate for Payer: Priority Health Narrow Network |
$338.18
|
| Rate for Payer: Priority Health SBD |
$338.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.04
|
| Rate for Payer: UHC Medicare Advantage |
$238.04
|
| Rate for Payer: UHCCP Medicaid |
$160.82
|
| 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 |
$160.82 |
| 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) |
$318.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.78
|
| Rate for Payer: BCBS Complete |
$168.86
|
| Rate for Payer: BCBS MAPPO |
$238.04
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$375.00
|
| 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: Meridian Medicaid |
$168.86
|
| 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 Choice Medicaid |
$160.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.18
|
| Rate for Payer: Priority Health Medicare |
$238.04
|
| Rate for Payer: Priority Health Narrow Network |
$338.18
|
| Rate for Payer: Priority Health SBD |
$338.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.04
|
| Rate for Payer: UHC Medicare Advantage |
$238.04
|
| Rate for Payer: UHCCP Medicaid |
$160.82
|
| 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
|
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 |
$2,166.65 |
| Rate for Payer: Aetna American Axle |
$180.70
|
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| 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 |
$222.40
|
| 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 |
$689.36
|
| 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 |
$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 |
$236.30
|
| 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 |
$236.30
|
| 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 |
$180.70
|
| 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 |
$175.14
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.03
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$126.39
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: UMR Bronson Commercial |
$102.86
|
| Rate for Payer: VA VA |
$689.36
|
| 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
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$205.36 |
| Rate for Payer: Aetna Commercial |
$167.47
|
| Rate for Payer: Aetna Medicare |
$129.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS MAPPO |
$124.98
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$205.36
|
| 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: Meridian Medicaid |
$90.35
|
| 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 Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.96
|
| Rate for Payer: Priority Health Medicare |
$124.98
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: Priority Health SBD |
$181.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.98
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
| 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
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$205.36 |
| Rate for Payer: Aetna Commercial |
$167.47
|
| Rate for Payer: Aetna Medicare |
$129.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.97
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS MAPPO |
$124.98
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$205.36
|
| 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: Meridian Medicaid |
$90.35
|
| 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 Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.96
|
| Rate for Payer: Priority Health Medicare |
$124.98
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: Priority Health SBD |
$181.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.98
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
| Rate for Payer: UMR Bronson Commercial |
$127.88
|
|
|
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
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna American Axle |
$229.45
|
| Rate for Payer: Aetna Commercial |
$300.05
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.45
|
| 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 |
$282.40
|
| 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 |
$689.36
|
| 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 |
$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 |
$300.05
|
| 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 |
$300.05
|
| 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 |
$229.45
|
| 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 |
$222.39
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.63
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$139.66
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: UMR Bronson Commercial |
$130.61
|
| Rate for Payer: VA VA |
$689.36
|
| 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
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$28.95 |
| 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) |
$185.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.83
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| 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: Meridian Medicaid |
$99.97
|
| 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 Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.48
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: Priority Health Narrow Network |
$200.48
|
| Rate for Payer: Priority Health SBD |
$200.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.77
|
| Rate for Payer: UHC Medicare Advantage |
$138.77
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
| 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
|
| Min. Negotiated Rate |
$28.95 |
| 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) |
$185.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.83
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| 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: Meridian Medicaid |
$99.97
|
| 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 Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.48
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: Priority Health Narrow Network |
$200.48
|
| Rate for Payer: Priority Health SBD |
$200.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.77
|
| Rate for Payer: UHC Medicare Advantage |
$138.77
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
| Rate for Payer: UMR Bronson Commercial |
$162.38
|
|
|
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 |
$116.09 |
| 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) |
$227.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.99
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS MAPPO |
$170.13
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| 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: Meridian Medicaid |
$121.89
|
| 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 Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.82
|
| Rate for Payer: Priority Health Medicare |
$170.13
|
| Rate for Payer: Priority Health Narrow Network |
$243.82
|
| Rate for Payer: Priority Health SBD |
$243.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.13
|
| Rate for Payer: UHC Medicare Advantage |
$170.13
|
| Rate for Payer: UHCCP Medicaid |
$116.09
|
| Rate for Payer: UMR Bronson Commercial |
$206.54
|
|
