PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$456.00
|
|
Service Code
|
CPT 11404
|
Hospital Charge Code |
11404
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$162.74 |
Max. Negotiated Rate |
$4,536.73 |
Rate for Payer: Aetna American Axle |
$296.40
|
Rate for Payer: Aetna Commercial |
$387.60
|
Rate for Payer: Aetna Medicare |
$1,498.78
|
Rate for Payer: Aetna New Business (MI Preferred) |
$296.40
|
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 |
$1,646.64
|
Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
Rate for Payer: Cash Price |
$364.80
|
Rate for Payer: Cash Price |
$364.80
|
Rate for Payer: Cofinity Commercial |
$319.20
|
Rate for Payer: Cofinity Commercial |
$392.16
|
Rate for Payer: Encore Health Key Benefits Commercial |
$364.80
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
Rate for Payer: Healthscope Commercial |
$410.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.00
|
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 |
$387.60
|
Rate for Payer: PACE Medicare |
$1,369.07
|
Rate for Payer: PACE SWMI |
$1,441.13
|
Rate for Payer: PHP Commercial |
$387.60
|
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 |
$319.20
|
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 |
$287.28
|
Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$179.01
|
Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
Rate for Payer: UHC Exchange |
$162.74
|
Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
Rate for Payer: UMR Bronson Commercial |
$168.72
|
Rate for Payer: VA VA |
$1,441.13
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.00
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$456.00
|
|
Service Code
|
HCPCS 11404
|
Min. Negotiated Rate |
$105.86 |
Max. Negotiated Rate |
$319.20 |
Rate for Payer: Aetna Commercial |
$174.54
|
Rate for Payer: BCBS Complete |
$111.15
|
Rate for Payer: BCBS Trust/PPO |
$302.17
|
Rate for Payer: Cash Price |
$364.80
|
Rate for Payer: Cash Price |
$364.80
|
Rate for Payer: Meridian Medicaid |
$111.15
|
Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.82
|
Rate for Payer: Priority Health Narrow Network |
$201.82
|
Rate for Payer: Priority Health SBD |
$201.82
|
Rate for Payer: UMR Bronson Commercial |
$209.76
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$456.00
|
|
Service Code
|
HCPCS 11404
|
Hospital Charge Code |
11404
|
Min. Negotiated Rate |
$105.86 |
Max. Negotiated Rate |
$319.20 |
Rate for Payer: Aetna Commercial |
$174.54
|
Rate for Payer: BCBS Complete |
$111.15
|
Rate for Payer: BCBS Trust/PPO |
$302.17
|
Rate for Payer: Cash Price |
$364.80
|
Rate for Payer: Cash Price |
$364.80
|
Rate for Payer: Meridian Medicaid |
$111.15
|
Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.82
|
Rate for Payer: Priority Health Narrow Network |
$201.82
|
Rate for Payer: Priority Health SBD |
$201.82
|
Rate for Payer: UMR Bronson Commercial |
$209.76
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$644.00
|
|
Service Code
|
CPT 11406
|
Hospital Charge Code |
11406
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$283.36 |
Max. Negotiated Rate |
$579.60 |
Rate for Payer: Aetna American Axle |
$418.60
|
Rate for Payer: Aetna Commercial |
$547.40
|
Rate for Payer: Aetna New Business (MI Preferred) |
$418.60
|
Rate for Payer: Cash Price |
$515.20
|
Rate for Payer: Cofinity Commercial |
$450.80
|
Rate for Payer: Cofinity Commercial |
$553.84
|
Rate for Payer: Encore Health Key Benefits Commercial |
$515.20
|
Rate for Payer: Healthscope Commercial |
$579.60
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$450.80
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$483.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$547.40
|
Rate for Payer: PHP Commercial |
$547.40
|
Rate for Payer: Priority Health Cigna Priority Health |
$450.80
|
Rate for Payer: Priority Health SBD |
$405.72
|
Rate for Payer: UMR Bronson Commercial |
$283.36
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$483.00
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$644.00
|
|
Service Code
|
HCPCS 11406
|
Hospital Charge Code |
11406
|
Min. Negotiated Rate |
$159.54 |
Max. Negotiated Rate |
$450.80 |
Rate for Payer: Aetna Commercial |
$266.88
|
Rate for Payer: BCBS Complete |
$167.52
|
Rate for Payer: BCBS Trust/PPO |
$201.42
|
Rate for Payer: Cash Price |
$515.20
|
Rate for Payer: Cash Price |
$515.20
|
Rate for Payer: Meridian Medicaid |
$167.52
|
Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
Rate for Payer: Priority Health Cigna Priority Health |
$450.80
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.76
|
Rate for Payer: Priority Health Narrow Network |
$303.76
|
Rate for Payer: Priority Health SBD |
$303.76
|
Rate for Payer: UMR Bronson Commercial |
$296.24
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$644.00
|
|
Service Code
|
CPT 11406
|
Hospital Charge Code |
11406
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$238.28 |
Max. Negotiated Rate |
$4,536.73 |
Rate for Payer: Aetna American Axle |
$418.60
|
Rate for Payer: Aetna Commercial |
$547.40
|
Rate for Payer: Aetna Medicare |
$1,498.78
|
Rate for Payer: Aetna New Business (MI Preferred) |
$418.60
|
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 |
$2,386.42
|
Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
Rate for Payer: Cash Price |
$515.20
|
Rate for Payer: Cash Price |
$515.20
|
Rate for Payer: Cofinity Commercial |
$553.84
|
Rate for Payer: Cofinity Commercial |
$450.80
|
Rate for Payer: Encore Health Key Benefits Commercial |
$515.20
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
Rate for Payer: Healthscope Commercial |
$579.60
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$450.80
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$483.00
|
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 |
$547.40
|
Rate for Payer: PACE Medicare |
$1,369.07
|
Rate for Payer: PACE SWMI |
$1,441.13
|
Rate for Payer: PHP Commercial |
$547.40
|
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 |
$450.80
|
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 |
$405.72
|
Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$269.78
|
Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
Rate for Payer: UHC Exchange |
$245.25
|
Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
Rate for Payer: UMR Bronson Commercial |
$238.28
|
Rate for Payer: VA VA |
$1,441.13
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$483.00
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$644.00
|
|
Service Code
|
HCPCS 11406
|
Min. Negotiated Rate |
$159.54 |
Max. Negotiated Rate |
$450.80 |
Rate for Payer: Aetna Commercial |
$266.88
|
Rate for Payer: BCBS Complete |
$167.52
|
Rate for Payer: BCBS Trust/PPO |
$201.42
|
Rate for Payer: Cash Price |
$515.20
|
Rate for Payer: Cash Price |
$515.20
|
Rate for Payer: Meridian Medicaid |
$167.52
|
Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
Rate for Payer: Priority Health Cigna Priority Health |
$450.80
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.76
|
Rate for Payer: Priority Health Narrow Network |
$303.76
|
Rate for Payer: Priority Health SBD |
$303.76
|
Rate for Payer: UMR Bronson Commercial |
$296.24
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$273.00
|
|
Service Code
|
HCPCS 11441
|
Min. Negotiated Rate |
$85.84 |
Max. Negotiated Rate |
$191.10 |
Rate for Payer: Aetna Commercial |
$139.29
|
Rate for Payer: BCBS Complete |
$90.13
|
Rate for Payer: BCBS Trust/PPO |
$185.19
|
Rate for Payer: Cash Price |
$218.40
|
Rate for Payer: Cash Price |
$218.40
|
Rate for Payer: Meridian Medicaid |
$90.13
|
Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.18
|
Rate for Payer: Priority Health Narrow Network |
$163.18
|
Rate for Payer: Priority Health SBD |
$163.18
|
Rate for Payer: UMR Bronson Commercial |
$125.58
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$273.00
|
|
Service Code
|
HCPCS 11441
|
Hospital Charge Code |
11441
|
Min. Negotiated Rate |
$85.84 |
Max. Negotiated Rate |
$191.10 |
Rate for Payer: Aetna Commercial |
$139.29
|
Rate for Payer: BCBS Complete |
$90.13
|
Rate for Payer: BCBS Trust/PPO |
$185.19
|
Rate for Payer: Cash Price |
$218.40
|
Rate for Payer: Cash Price |
$218.40
|
Rate for Payer: Meridian Medicaid |
$90.13
|
Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.18
|
Rate for Payer: Priority Health Narrow Network |
$163.18
|
Rate for Payer: Priority Health SBD |
$163.18
|
Rate for Payer: UMR Bronson Commercial |
$125.58
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$273.00
|
|
Service Code
|
CPT 11441
|
Hospital Charge Code |
11441
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$101.01 |
Max. Negotiated Rate |
$1,968.76 |
Rate for Payer: Aetna American Axle |
$177.45
|
Rate for Payer: Aetna Commercial |
$232.05
|
Rate for Payer: Aetna Medicare |
$650.41
|
Rate for Payer: Aetna New Business (MI Preferred) |
$177.45
|
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 |
$218.40
|
Rate for Payer: Cash Price |
$218.40
|
Rate for Payer: Cofinity Commercial |
$191.10
|
Rate for Payer: Cofinity Commercial |
$234.78
|
Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
Rate for Payer: Healthscope Commercial |
$245.70
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.10
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.75
|
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 |
$232.05
|
Rate for Payer: PACE Medicare |
$594.12
|
Rate for Payer: PACE SWMI |
$625.39
|
Rate for Payer: PHP Commercial |
$232.05
|
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 |
$191.10
|
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 |
$171.99
|
Rate for Payer: Railroad Medicare Medicare |
$625.39
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$145.16
|
Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
Rate for Payer: UHC Exchange |
$131.96
|
Rate for Payer: UHC Medicare Advantage |
$644.15
|
Rate for Payer: UMR Bronson Commercial |
$101.01
|
Rate for Payer: VA VA |
$625.39
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.75
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$273.00
|
|
Service Code
|
CPT 11441
|
Hospital Charge Code |
11441
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$120.12 |
Max. Negotiated Rate |
$245.70 |
Rate for Payer: Aetna American Axle |
$177.45
|
Rate for Payer: Aetna Commercial |
$232.05
|
Rate for Payer: Aetna New Business (MI Preferred) |
$177.45
|
Rate for Payer: Cash Price |
$218.40
|
Rate for Payer: Cofinity Commercial |
$191.10
|
Rate for Payer: Cofinity Commercial |
$234.78
|
Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
Rate for Payer: Healthscope Commercial |
$245.70
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.10
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.75
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.05
|
Rate for Payer: PHP Commercial |
$232.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
Rate for Payer: Priority Health SBD |
$171.99
|
Rate for Payer: UMR Bronson Commercial |
$120.12
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.75
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$346.00
|
|
Service Code
|
HCPCS 11442
|
Min. Negotiated Rate |
$28.95 |
Max. Negotiated Rate |
$242.20 |
Rate for Payer: Aetna Commercial |
$154.20
|
Rate for Payer: BCBS Complete |
$99.30
|
Rate for Payer: BCBS Trust/PPO |
$28.95
|
Rate for Payer: Cash Price |
$276.80
|
Rate for Payer: Cash Price |
$276.80
|
Rate for Payer: Meridian Medicaid |
$99.30
|
Rate for Payer: Priority Health Choice Medicaid |
$94.57
|
Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.04
|
Rate for Payer: Priority Health Narrow Network |
$180.04
|
Rate for Payer: Priority Health SBD |
$180.04
|
Rate for Payer: UMR Bronson Commercial |
$159.16
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$346.00
|
|
Service Code
|
CPT 11442
|
Hospital Charge Code |
11442
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$128.02 |
Max. Negotiated Rate |
$1,968.76 |
Rate for Payer: Aetna American Axle |
$224.90
|
Rate for Payer: Aetna Commercial |
$294.10
|
Rate for Payer: Aetna Medicare |
$650.41
|
Rate for Payer: Aetna New Business (MI Preferred) |
$224.90
|
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 |
$276.80
|
Rate for Payer: Cash Price |
$276.80
|
Rate for Payer: Cofinity Commercial |
$242.20
|
Rate for Payer: Cofinity Commercial |
$297.56
|
Rate for Payer: Encore Health Key Benefits Commercial |
$276.80
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
Rate for Payer: Healthscope Commercial |
$311.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.50
|
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 |
$294.10
|
Rate for Payer: PACE Medicare |
$594.12
|
Rate for Payer: PACE SWMI |
$625.39
|
Rate for Payer: PHP Commercial |
$294.10
|
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 |
$242.20
|
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 |
$217.98
|
Rate for Payer: Railroad Medicare Medicare |
$625.39
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$159.92
|
Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
Rate for Payer: UHC Exchange |
$145.38
|
Rate for Payer: UHC Medicare Advantage |
$644.15
|
Rate for Payer: UMR Bronson Commercial |
$128.02
|
Rate for Payer: VA VA |
$625.39
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.50
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$346.00
|
|
Service Code
|
HCPCS 11442
|
Hospital Charge Code |
11442
|
Min. Negotiated Rate |
$28.95 |
Max. Negotiated Rate |
$242.20 |
Rate for Payer: Aetna Commercial |
$154.20
|
Rate for Payer: BCBS Complete |
$99.30
|
Rate for Payer: BCBS Trust/PPO |
$28.95
|
Rate for Payer: Cash Price |
$276.80
|
Rate for Payer: Cash Price |
$276.80
|
Rate for Payer: Meridian Medicaid |
$99.30
|
Rate for Payer: Priority Health Choice Medicaid |
$94.57
|
Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.04
|
Rate for Payer: Priority Health Narrow Network |
$180.04
|
Rate for Payer: Priority Health SBD |
$180.04
|
Rate for Payer: UMR Bronson Commercial |
$159.16
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$346.00
|
|
Service Code
|
CPT 11442
|
Hospital Charge Code |
11442
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$152.24 |
Max. Negotiated Rate |
$311.40 |
Rate for Payer: Aetna American Axle |
$224.90
|
Rate for Payer: Aetna Commercial |
$294.10
|
Rate for Payer: Aetna New Business (MI Preferred) |
$224.90
|
Rate for Payer: Cash Price |
$276.80
|
Rate for Payer: Cofinity Commercial |
$242.20
|
Rate for Payer: Cofinity Commercial |
$297.56
|
Rate for Payer: Encore Health Key Benefits Commercial |
$276.80
|
Rate for Payer: Healthscope Commercial |
$311.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.10
|
Rate for Payer: PHP Commercial |
$294.10
|
Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
Rate for Payer: Priority Health SBD |
$217.98
|
Rate for Payer: UMR Bronson Commercial |
$152.24
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.50
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$440.00
|
|
Service Code
|
HCPCS 11443
|
Min. Negotiated Rate |
$115.02 |
Max. Negotiated Rate |
$308.00 |
Rate for Payer: Aetna Commercial |
$189.95
|
Rate for Payer: BCBS Complete |
$120.77
|
Rate for Payer: BCBS Trust/PPO |
$125.51
|
Rate for Payer: Cash Price |
$352.00
|
Rate for Payer: Cash Price |
$352.00
|
Rate for Payer: Meridian Medicaid |
$120.77
|
Rate for Payer: Priority Health Choice Medicaid |
$115.02
|
Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.09
|
Rate for Payer: Priority Health Narrow Network |
$219.09
|
Rate for Payer: Priority Health SBD |
$219.09
|
Rate for Payer: UMR Bronson Commercial |
$202.40
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
OP
|
$440.00
|
|
Service Code
|
CPT 11443
|
Hospital Charge Code |
11443
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$162.80 |
Max. Negotiated Rate |
$4,536.73 |
Rate for Payer: Aetna American Axle |
$286.00
|
Rate for Payer: Aetna Commercial |
$374.00
|
Rate for Payer: Aetna Medicare |
$1,498.78
|
Rate for Payer: Aetna New Business (MI Preferred) |
$286.00
|
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 |
$352.00
|
Rate for Payer: Cash Price |
$352.00
|
Rate for Payer: Cofinity Commercial |
$378.40
|
Rate for Payer: Cofinity Commercial |
$308.00
|
Rate for Payer: Encore Health Key Benefits Commercial |
$352.00
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
Rate for Payer: Healthscope Commercial |
$396.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.00
|
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 |
$374.00
|
Rate for Payer: PACE Medicare |
$1,369.07
|
Rate for Payer: PACE SWMI |
$1,441.13
|
Rate for Payer: PHP Commercial |
$374.00
|
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 |
$308.00
|
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 |
$277.20
|
Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$194.50
|
Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
Rate for Payer: UHC Exchange |
$176.82
|
Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
Rate for Payer: UMR Bronson Commercial |
$162.80
|
Rate for Payer: VA VA |
$1,441.13
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.00
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
IP
|
$440.00
|
|
Service Code
|
CPT 11443
|
Hospital Charge Code |
11443
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$193.60 |
Max. Negotiated Rate |
$396.00 |
Rate for Payer: Aetna American Axle |
$286.00
|
Rate for Payer: Aetna Commercial |
$374.00
|
Rate for Payer: Aetna New Business (MI Preferred) |
$286.00
|
Rate for Payer: Cash Price |
$352.00
|
Rate for Payer: Cofinity Commercial |
$308.00
|
Rate for Payer: Cofinity Commercial |
$378.40
|
Rate for Payer: Encore Health Key Benefits Commercial |
$352.00
|
Rate for Payer: Healthscope Commercial |
$396.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.00
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.00
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.00
|
Rate for Payer: PHP Commercial |
$374.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
Rate for Payer: Priority Health SBD |
$277.20
|
Rate for Payer: UMR Bronson Commercial |
$193.60
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.00
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$440.00
|
|
Service Code
|
HCPCS 11443
|
Hospital Charge Code |
11443
|
Min. Negotiated Rate |
$115.02 |
Max. Negotiated Rate |
$308.00 |
Rate for Payer: Aetna Commercial |
$189.95
|
Rate for Payer: BCBS Complete |
$120.77
|
Rate for Payer: BCBS Trust/PPO |
$125.51
|
Rate for Payer: Cash Price |
$352.00
|
Rate for Payer: Cash Price |
$352.00
|
Rate for Payer: Meridian Medicaid |
$120.77
|
Rate for Payer: Priority Health Choice Medicaid |
$115.02
|
Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.09
|
Rate for Payer: Priority Health Narrow Network |
$219.09
|
Rate for Payer: Priority Health SBD |
$219.09
|
Rate for Payer: UMR Bronson Commercial |
$202.40
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
OP
|
$566.00
|
|
Service Code
|
CPT 11444
|
Hospital Charge Code |
11444
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$209.42 |
Max. Negotiated Rate |
$4,536.73 |
Rate for Payer: Aetna American Axle |
$367.90
|
Rate for Payer: Aetna Commercial |
$481.10
|
Rate for Payer: Aetna Medicare |
$1,498.78
|
Rate for Payer: Aetna New Business (MI Preferred) |
$367.90
|
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 |
$903.27
|
Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
Rate for Payer: Cash Price |
$452.80
|
Rate for Payer: Cash Price |
$452.80
|
Rate for Payer: Cofinity Commercial |
$486.76
|
Rate for Payer: Cofinity Commercial |
$396.20
|
Rate for Payer: Encore Health Key Benefits Commercial |
$452.80
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
Rate for Payer: Healthscope Commercial |
$509.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$396.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.50
|
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 |
$481.10
|
Rate for Payer: PACE Medicare |
$1,369.07
|
Rate for Payer: PACE SWMI |
$1,441.13
|
Rate for Payer: PHP Commercial |
$481.10
|
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 |
$396.20
|
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 |
$356.58
|
Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$244.56
|
Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
Rate for Payer: UHC Exchange |
$222.33
|
Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
Rate for Payer: UMR Bronson Commercial |
$209.42
|
Rate for Payer: VA VA |
$1,441.13
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.50
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
IP
|
$566.00
|
|
Service Code
|
CPT 11444
|
Hospital Charge Code |
11444
|
Hospital Revenue Code
|
521
|
Min. Negotiated Rate |
$249.04 |
Max. Negotiated Rate |
$509.40 |
Rate for Payer: Aetna American Axle |
$367.90
|
Rate for Payer: Aetna Commercial |
$481.10
|
Rate for Payer: Aetna New Business (MI Preferred) |
$367.90
|
Rate for Payer: Cash Price |
$452.80
|
Rate for Payer: Cofinity Commercial |
$396.20
|
Rate for Payer: Cofinity Commercial |
$486.76
|
Rate for Payer: Encore Health Key Benefits Commercial |
$452.80
|
Rate for Payer: Healthscope Commercial |
$509.40
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$396.20
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.50
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$481.10
|
Rate for Payer: PHP Commercial |
$481.10
|
Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
Rate for Payer: Priority Health SBD |
$356.58
|
Rate for Payer: UMR Bronson Commercial |
$249.04
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.50
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$566.00
|
|
Service Code
|
HCPCS 11444
|
Min. Negotiated Rate |
$144.63 |
Max. Negotiated Rate |
$540.00 |
Rate for Payer: Aetna Commercial |
$242.15
|
Rate for Payer: BCBS Complete |
$151.86
|
Rate for Payer: BCBS Trust/PPO |
$540.00
|
Rate for Payer: Cash Price |
$452.80
|
Rate for Payer: Cash Price |
$452.80
|
Rate for Payer: Meridian Medicaid |
$151.86
|
Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.22
|
Rate for Payer: Priority Health Narrow Network |
$276.22
|
Rate for Payer: Priority Health SBD |
$276.22
|
Rate for Payer: UMR Bronson Commercial |
$260.36
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$566.00
|
|
Service Code
|
HCPCS 11444
|
Hospital Charge Code |
11444
|
Min. Negotiated Rate |
$144.63 |
Max. Negotiated Rate |
$540.00 |
Rate for Payer: Aetna Commercial |
$242.15
|
Rate for Payer: BCBS Complete |
$151.86
|
Rate for Payer: BCBS Trust/PPO |
$540.00
|
Rate for Payer: Cash Price |
$452.80
|
Rate for Payer: Cash Price |
$452.80
|
Rate for Payer: Meridian Medicaid |
$151.86
|
Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
Rate for Payer: Priority Health Cigna Priority Health |
$396.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.22
|
Rate for Payer: Priority Health Narrow Network |
$276.22
|
Rate for Payer: Priority Health SBD |
$276.22
|
Rate for Payer: UMR Bronson Commercial |
$260.36
|
|
PR EXC BARTHOLINS GLAND/CYST
|
Professional
|
Both
|
$911.00
|
|
Service Code
|
HCPCS 56740
|
Min. Negotiated Rate |
$202.78 |
Max. Negotiated Rate |
$1,879.16 |
Rate for Payer: Aetna Commercial |
$372.87
|
Rate for Payer: BCBS Complete |
$212.92
|
Rate for Payer: BCBS Trust/PPO |
$1,879.16
|
Rate for Payer: Cash Price |
$728.80
|
Rate for Payer: Cash Price |
$728.80
|
Rate for Payer: Meridian Medicaid |
$212.92
|
Rate for Payer: Priority Health Choice Medicaid |
$202.78
|
Rate for Payer: Priority Health Cigna Priority Health |
$637.70
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$448.81
|
Rate for Payer: Priority Health Narrow Network |
$448.81
|
Rate for Payer: Priority Health SBD |
$448.81
|
Rate for Payer: UMR Bronson Commercial |
$419.06
|
|
PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN
|
Professional
|
Both
|
$7,827.00
|
|
Service Code
|
HCPCS 61563
|
Min. Negotiated Rate |
$382.49 |
Max. Negotiated Rate |
$5,478.90 |
Rate for Payer: Aetna Commercial |
$2,563.18
|
Rate for Payer: BCBS Complete |
$1,350.63
|
Rate for Payer: BCBS Trust/PPO |
$382.49
|
Rate for Payer: Cash Price |
$6,261.60
|
Rate for Payer: Cash Price |
$6,261.60
|
Rate for Payer: Meridian Medicaid |
$1,350.63
|
Rate for Payer: Priority Health Choice Medicaid |
$1,286.31
|
Rate for Payer: Priority Health Cigna Priority Health |
$5,478.90
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,388.85
|
Rate for Payer: Priority Health Narrow Network |
$3,388.85
|
Rate for Payer: Priority Health SBD |
$3,388.85
|
Rate for Payer: UMR Bronson Commercial |
$3,600.42
|
|