|
PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$2,120.00
|
|
|
Service Code
|
HCPCS 34718
|
| Min. Negotiated Rate |
$770.63 |
| Max. Negotiated Rate |
$1,914.51 |
| Rate for Payer: Aetna Commercial |
$1,652.85
|
| Rate for Payer: BCBS Complete |
$809.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.62
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Cash Price |
$1,696.00
|
| Rate for Payer: Meridian Medicaid |
$809.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,484.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,914.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,914.51
|
| Rate for Payer: Priority Health SBD |
$1,914.51
|
| Rate for Payer: UMR Bronson Commercial |
$975.20
|
|
|
PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 34717
|
| Min. Negotiated Rate |
$274.98 |
| Max. Negotiated Rate |
$1,145.35 |
| Rate for Payer: Aetna Commercial |
$594.51
|
| Rate for Payer: BCBS Complete |
$288.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,145.35
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Meridian Medicaid |
$288.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$685.17
|
| Rate for Payer: Priority Health Narrow Network |
$685.17
|
| Rate for Payer: Priority Health SBD |
$685.17
|
| Rate for Payer: UMR Bronson Commercial |
$364.78
|
|
|
PR EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK
|
Professional
|
Both
|
$3,271.00
|
|
|
Service Code
|
HCPCS 61623
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$2,289.70 |
| Rate for Payer: Aetna Commercial |
$737.47
|
| Rate for Payer: BCBS Complete |
$385.57
|
| Rate for Payer: BCBS Trust/PPO |
$124.15
|
| Rate for Payer: Cash Price |
$2,616.80
|
| Rate for Payer: Cash Price |
$2,616.80
|
| Rate for Payer: Meridian Medicaid |
$385.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,289.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.63
|
| Rate for Payer: Priority Health Narrow Network |
$971.63
|
| Rate for Payer: Priority Health SBD |
$971.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,504.66
|
|
|
PR EWHO RIGID W/O JNTS CF
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS L3763
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$479.50 |
| Rate for Payer: Aetna Commercial |
$410.20
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: UMR Bronson Commercial |
$315.10
|
|
|
PR EWHO W/JOINT(S) CF
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS L3764
|
| Min. Negotiated Rate |
$286.80 |
| Max. Negotiated Rate |
$501.90 |
| Rate for Payer: Aetna Commercial |
$429.28
|
| Rate for Payer: BCBS Complete |
$286.80
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.90
|
| Rate for Payer: UMR Bronson Commercial |
$329.82
|
|
|
PR EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM
|
Professional
|
Both
|
$2,332.00
|
|
|
Service Code
|
HCPCS 44110
|
| Min. Negotiated Rate |
$543.79 |
| Max. Negotiated Rate |
$1,643.01 |
| Rate for Payer: Aetna Commercial |
$1,141.78
|
| Rate for Payer: BCBS Complete |
$570.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.01
|
| Rate for Payer: Cash Price |
$1,865.60
|
| Rate for Payer: Cash Price |
$1,865.60
|
| Rate for Payer: Meridian Medicaid |
$570.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$543.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,632.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,485.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,485.81
|
| Rate for Payer: Priority Health SBD |
$1,485.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,072.72
|
|
|
PR EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE
|
Professional
|
Both
|
$3,534.00
|
|
|
Service Code
|
HCPCS 44111
|
| Min. Negotiated Rate |
$266.79 |
| Max. Negotiated Rate |
$2,473.80 |
| Rate for Payer: Aetna Commercial |
$1,314.35
|
| Rate for Payer: BCBS Complete |
$655.52
|
| Rate for Payer: BCBS Trust/PPO |
$266.79
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Cash Price |
$2,827.20
|
| Rate for Payer: Meridian Medicaid |
$655.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$624.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,473.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,726.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,726.88
|
| Rate for Payer: Priority Health SBD |
$1,726.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,625.64
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$81.40 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$143.00
|
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$694.01
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Cofinity Commercial |
$154.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Priority Health SBD |
$138.60
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$106.09
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$81.40
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 11440
|
| Hospital Charge Code |
11440
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$109.82
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.30
|
| Rate for Payer: Priority Health Narrow Network |
$130.30
|
| Rate for Payer: Priority Health SBD |
$130.30
|
| Rate for Payer: UMR Bronson Commercial |
$101.20
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 11440
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$109.82
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.30
|
| Rate for Payer: Priority Health Narrow Network |
$130.30
|
| Rate for Payer: Priority Health SBD |
$130.30
|
| Rate for Payer: UMR Bronson Commercial |
$101.20
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 11440
|
| Hospital Charge Code |
11440
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna American Axle |
$143.00
|
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$154.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health SBD |
$138.60
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 11446
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$345.75
|
| Rate for Payer: BCBS Complete |
$213.14
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Meridian Medicaid |
$213.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.79
|
| Rate for Payer: Priority Health Narrow Network |
$386.79
|
| Rate for Payer: Priority Health SBD |
$386.79
|
| Rate for Payer: UMR Bronson Commercial |
$372.60
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 11420
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$139.30 |
| Rate for Payer: Aetna Commercial |
$87.38
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS Trust/PPO |
$100.72
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.70
|
| Rate for Payer: Priority Health Narrow Network |
$100.70
|
| Rate for Payer: Priority Health SBD |
$100.70
|
| Rate for Payer: UMR Bronson Commercial |
$91.54
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
11421
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: BCBS Complete |
$73.58
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Meridian Medicaid |
$73.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.41
|
| Rate for Payer: Priority Health Narrow Network |
$134.41
|
| Rate for Payer: Priority Health SBD |
$134.41
|
| Rate for Payer: UMR Bronson Commercial |
$117.76
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 11421
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: BCBS Complete |
$73.58
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Meridian Medicaid |
$73.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.41
|
| Rate for Payer: Priority Health Narrow Network |
$134.41
|
| Rate for Payer: Priority Health SBD |
$134.41
|
| Rate for Payer: UMR Bronson Commercial |
$117.76
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$112.64 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna American Axle |
$166.40
|
| Rate for Payer: Aetna Commercial |
$217.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.40
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$230.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.60
|
| Rate for Payer: PHP Commercial |
$217.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health SBD |
$161.28
|
| Rate for Payer: UMR Bronson Commercial |
$112.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$166.40
|
| Rate for Payer: Aetna Commercial |
$217.60
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$694.01
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$220.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$230.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.00
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.60
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$217.60
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Priority Health SBD |
$161.28
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$107.73
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$94.72
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
11422
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: UMR Bronson Commercial |
$125.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
11422
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$199.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$134.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$105.45
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
11422
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna Commercial |
$143.70
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$32.57
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.47
|
| Rate for Payer: Priority Health Narrow Network |
$166.47
|
| Rate for Payer: Priority Health SBD |
$166.47
|
| Rate for Payer: UMR Bronson Commercial |
$131.10
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 11422
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna Commercial |
$143.70
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$32.57
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.47
|
| Rate for Payer: Priority Health Narrow Network |
$166.47
|
| Rate for Payer: Priority Health SBD |
$166.47
|
| Rate for Payer: UMR Bronson Commercial |
$131.10
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
11423
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$172.92 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Aetna American Axle |
$255.45
|
| Rate for Payer: Aetna Commercial |
$334.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.45
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cofinity Commercial |
$275.10
|
| Rate for Payer: Cofinity Commercial |
$337.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.40
|
| Rate for Payer: Healthscope Commercial |
$353.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.05
|
| Rate for Payer: PHP Commercial |
$334.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.10
|
| Rate for Payer: Priority Health SBD |
$247.59
|
| Rate for Payer: UMR Bronson Commercial |
$172.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
11423
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$145.41 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$255.45
|
| Rate for Payer: Aetna Commercial |
$334.05
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cofinity Commercial |
$337.98
|
| Rate for Payer: Cofinity Commercial |
$275.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$353.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.75
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$334.05
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$334.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$247.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$155.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$145.41
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
11423
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.54
|
| Rate for Payer: Priority Health Narrow Network |
$191.54
|
| Rate for Payer: Priority Health SBD |
$191.54
|
| Rate for Payer: UMR Bronson Commercial |
$180.78
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 11423
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: BCBS Complete |
$106.01
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Meridian Medicaid |
$106.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.54
|
| Rate for Payer: Priority Health Narrow Network |
$191.54
|
| Rate for Payer: Priority Health SBD |
$191.54
|
| Rate for Payer: UMR Bronson Commercial |
$180.78
|
|
