|
PR EXCISION LESION PANCREAS
|
Professional
|
Both
|
$2,230.00
|
|
|
Service Code
|
HCPCS 48120
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$1,959.12 |
| Rate for Payer: Aetna Commercial |
$1,496.65
|
| Rate for Payer: BCBS Complete |
$748.11
|
| Rate for Payer: BCBS Trust/PPO |
$203.40
|
| Rate for Payer: Cash Price |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,784.00
|
| Rate for Payer: Meridian Medicaid |
$748.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$712.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,561.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,959.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,959.12
|
| Rate for Payer: Priority Health SBD |
$1,959.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,025.80
|
|
|
PR EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK
|
Professional
|
Both
|
$1,318.00
|
|
|
Service Code
|
HCPCS 27630
|
| Min. Negotiated Rate |
$231.74 |
| Max. Negotiated Rate |
$922.60 |
| Rate for Payer: Aetna Commercial |
$477.87
|
| Rate for Payer: BCBS Complete |
$243.33
|
| Rate for Payer: BCBS Trust/PPO |
$600.15
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Cash Price |
$1,054.40
|
| Rate for Payer: Meridian Medicaid |
$243.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$922.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.87
|
| Rate for Payer: Priority Health Narrow Network |
$544.87
|
| Rate for Payer: Priority Health SBD |
$544.87
|
| Rate for Payer: UMR Bronson Commercial |
$606.28
|
|
|
PR EXCISION LESION TENDON SHEATH FOREARM&/WRIST
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
HCPCS 25110
|
| Min. Negotiated Rate |
$212.38 |
| Max. Negotiated Rate |
$792.40 |
| Rate for Payer: Aetna Commercial |
$456.59
|
| Rate for Payer: BCBS Complete |
$238.41
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Meridian Medicaid |
$238.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.25
|
| Rate for Payer: Priority Health Narrow Network |
$539.25
|
| Rate for Payer: Priority Health SBD |
$539.25
|
| Rate for Payer: UMR Bronson Commercial |
$520.72
|
|
|
PR EXCISION LESION TONGUE W/O CLOSURE
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 41110
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$170.28
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.90
|
| Rate for Payer: Priority Health Narrow Network |
$229.90
|
| Rate for Payer: Priority Health SBD |
$229.90
|
| Rate for Payer: UMR Bronson Commercial |
$172.04
|
|
|
PR EXCISION LINGUAL FRENUM FRENECTOMY
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 41115
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$967.85 |
| Rate for Payer: Aetna Commercial |
$191.54
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS Trust/PPO |
$967.85
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Meridian Medicaid |
$98.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.70
|
| Rate for Payer: Priority Health Narrow Network |
$258.70
|
| Rate for Payer: Priority Health SBD |
$258.70
|
| Rate for Payer: UMR Bronson Commercial |
$201.48
|
|
|
PR EXCISION LOCAL LESION EPIDIDYMIS
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 54830
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,910.86 |
| Rate for Payer: Aetna Commercial |
$476.03
|
| Rate for Payer: BCBS Complete |
$251.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,910.86
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Meridian Medicaid |
$251.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$597.09
|
| Rate for Payer: Priority Health Narrow Network |
$597.09
|
| Rate for Payer: Priority Health SBD |
$597.09
|
| Rate for Payer: UMR Bronson Commercial |
$278.30
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$143.44 |
| Max. Negotiated Rate |
$293.40 |
| Rate for Payer: Aetna American Axle |
$211.90
|
| Rate for Payer: Aetna Commercial |
$277.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.90
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cofinity Commercial |
$228.20
|
| Rate for Payer: Cofinity Commercial |
$280.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.80
|
| Rate for Payer: Healthscope Commercial |
$293.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.10
|
| Rate for Payer: PHP Commercial |
$277.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
| Rate for Payer: Priority Health SBD |
$205.38
|
| Rate for Payer: UMR Bronson Commercial |
$143.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.50
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 11640
|
| Hospital Charge Code |
11640
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$977.96 |
| Rate for Payer: Aetna Commercial |
$134.58
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS Trust/PPO |
$977.96
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.56
|
| Rate for Payer: Priority Health Narrow Network |
$154.56
|
| Rate for Payer: Priority Health SBD |
$154.56
|
| Rate for Payer: UMR Bronson Commercial |
$149.96
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
11640
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.62 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$211.90
|
| Rate for Payer: Aetna Commercial |
$277.10
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.90
|
| 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 |
$170.71
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cofinity Commercial |
$280.36
|
| Rate for Payer: Cofinity Commercial |
$228.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$293.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.50
|
| 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 |
$277.10
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$277.10
|
| 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 |
$228.20
|
| 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 |
$205.38
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$124.76
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$120.62
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.50
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 11640
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$977.96 |
| Rate for Payer: Aetna Commercial |
$134.58
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS Trust/PPO |
$977.96
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.56
|
| Rate for Payer: Priority Health Narrow Network |
$154.56
|
| Rate for Payer: Priority Health SBD |
$154.56
|
| Rate for Payer: UMR Bronson Commercial |
$149.96
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 11641
|
| Hospital Charge Code |
11641
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$1,307.96 |
| Rate for Payer: Aetna Commercial |
$165.44
|
| Rate for Payer: BCBS Complete |
$104.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,307.96
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Meridian Medicaid |
$104.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.90
|
| Rate for Payer: Priority Health Narrow Network |
$189.90
|
| Rate for Payer: Priority Health SBD |
$189.90
|
| Rate for Payer: UMR Bronson Commercial |
$177.56
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
11641
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$142.82 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$250.90
|
| Rate for Payer: Aetna Commercial |
$328.10
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.90
|
| 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 |
$192.88
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$270.20
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$347.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.50
|
| 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 |
$328.10
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$328.10
|
| 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 |
$270.20
|
| 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 |
$243.18
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$142.82
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.50
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
11641
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$169.84 |
| Max. Negotiated Rate |
$347.40 |
| Rate for Payer: Aetna American Axle |
$250.90
|
| Rate for Payer: Aetna Commercial |
$328.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.90
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$270.20
|
| Rate for Payer: Cofinity Commercial |
$331.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.80
|
| Rate for Payer: Healthscope Commercial |
$347.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$328.10
|
| Rate for Payer: PHP Commercial |
$328.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.20
|
| Rate for Payer: Priority Health SBD |
$243.18
|
| Rate for Payer: UMR Bronson Commercial |
$169.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.50
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 11641
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$1,307.96 |
| Rate for Payer: Aetna Commercial |
$165.44
|
| Rate for Payer: BCBS Complete |
$104.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,307.96
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Meridian Medicaid |
$104.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.90
|
| Rate for Payer: Priority Health Narrow Network |
$189.90
|
| Rate for Payer: Priority Health SBD |
$189.90
|
| Rate for Payer: UMR Bronson Commercial |
$177.56
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
11642
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$256.96 |
| Max. Negotiated Rate |
$525.60 |
| Rate for Payer: Aetna American Axle |
$379.60
|
| Rate for Payer: Aetna Commercial |
$496.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.60
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cofinity Commercial |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$502.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.20
|
| Rate for Payer: Healthscope Commercial |
$525.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.40
|
| Rate for Payer: PHP Commercial |
$496.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.80
|
| Rate for Payer: Priority Health SBD |
$367.92
|
| Rate for Payer: UMR Bronson Commercial |
$256.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.00
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 11642
|
| Hospital Charge Code |
11642
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Aetna Commercial |
$194.03
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS Trust/PPO |
$712.50
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.55
|
| Rate for Payer: Priority Health Narrow Network |
$221.55
|
| Rate for Payer: Priority Health SBD |
$221.55
|
| Rate for Payer: UMR Bronson Commercial |
$268.64
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 11642
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Aetna Commercial |
$194.03
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS Trust/PPO |
$712.50
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.55
|
| Rate for Payer: Priority Health Narrow Network |
$221.55
|
| Rate for Payer: Priority Health SBD |
$221.55
|
| Rate for Payer: UMR Bronson Commercial |
$268.64
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
11642
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$379.60
|
| Rate for Payer: Aetna Commercial |
$496.40
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.60
|
| 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 |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cofinity Commercial |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$502.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$525.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.00
|
| 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 |
$496.40
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$496.40
|
| 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 |
$408.80
|
| 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 |
$367.92
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$178.46
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$216.08
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.00
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
11643
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Aetna American Axle |
$474.50
|
| Rate for Payer: Aetna Commercial |
$620.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.50
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cofinity Commercial |
$511.00
|
| Rate for Payer: Cofinity Commercial |
$627.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.00
|
| Rate for Payer: Healthscope Commercial |
$657.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$620.50
|
| Rate for Payer: PHP Commercial |
$620.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.00
|
| Rate for Payer: Priority Health SBD |
$459.90
|
| Rate for Payer: UMR Bronson Commercial |
$321.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.50
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 11643
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$511.00 |
| Rate for Payer: Aetna Commercial |
$243.96
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Meridian Medicaid |
$151.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.04
|
| Rate for Payer: Priority Health Narrow Network |
$277.04
|
| Rate for Payer: Priority Health SBD |
$277.04
|
| Rate for Payer: UMR Bronson Commercial |
$335.80
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
11643
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$222.33 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$474.50
|
| Rate for Payer: Aetna Commercial |
$620.50
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.50
|
| 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 |
$584.00
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cofinity Commercial |
$511.00
|
| Rate for Payer: Cofinity Commercial |
$627.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$657.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.50
|
| 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 |
$620.50
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$620.50
|
| 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 |
$511.00
|
| 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 |
$459.90
|
| 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 |
$270.10
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.50
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
11643
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$511.00 |
| Rate for Payer: Aetna Commercial |
$243.96
|
| Rate for Payer: BCBS Complete |
$151.86
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Cash Price |
$584.00
|
| Rate for Payer: Meridian Medicaid |
$151.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.04
|
| Rate for Payer: Priority Health Narrow Network |
$277.04
|
| Rate for Payer: Priority Health SBD |
$277.04
|
| Rate for Payer: UMR Bronson Commercial |
$335.80
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
11644
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$397.76 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Aetna American Axle |
$587.60
|
| Rate for Payer: Aetna Commercial |
$768.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.60
|
| Rate for Payer: Cash Price |
$723.20
|
| Rate for Payer: Cofinity Commercial |
$632.80
|
| Rate for Payer: Cofinity Commercial |
$777.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.20
|
| Rate for Payer: Healthscope Commercial |
$813.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$632.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.40
|
| Rate for Payer: PHP Commercial |
$768.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.80
|
| Rate for Payer: Priority Health SBD |
$569.52
|
| Rate for Payer: UMR Bronson Commercial |
$397.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.00
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$904.00
|
|
|
Service Code
|
HCPCS 11644
|
| Min. Negotiated Rate |
$179.13 |
| Max. Negotiated Rate |
$655.87 |
| Rate for Payer: Aetna Commercial |
$303.84
|
| Rate for Payer: BCBS Complete |
$188.09
|
| Rate for Payer: BCBS Trust/PPO |
$655.87
|
| Rate for Payer: Cash Price |
$723.20
|
| Rate for Payer: Cash Price |
$723.20
|
| Rate for Payer: Meridian Medicaid |
$188.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.63
|
| Rate for Payer: Priority Health Narrow Network |
$343.63
|
| Rate for Payer: Priority Health SBD |
$343.63
|
| Rate for Payer: UMR Bronson Commercial |
$415.84
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$904.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
11644
|
| Min. Negotiated Rate |
$179.13 |
| Max. Negotiated Rate |
$655.87 |
| Rate for Payer: Aetna Commercial |
$303.84
|
| Rate for Payer: BCBS Complete |
$188.09
|
| Rate for Payer: BCBS Trust/PPO |
$655.87
|
| Rate for Payer: Cash Price |
$723.20
|
| Rate for Payer: Cash Price |
$723.20
|
| Rate for Payer: Meridian Medicaid |
$188.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.63
|
| Rate for Payer: Priority Health Narrow Network |
$343.63
|
| Rate for Payer: Priority Health SBD |
$343.63
|
| Rate for Payer: UMR Bronson Commercial |
$415.84
|
|
