|
PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
11606
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$291.19 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$511.55
|
| Rate for Payer: Aetna Commercial |
$668.95
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.55
|
| 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 |
$2,250.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cofinity Commercial |
$550.90
|
| Rate for Payer: Cofinity Commercial |
$676.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$708.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$550.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.25
|
| 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 |
$668.95
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$668.95
|
| 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 |
$550.90
|
| 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 |
$495.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$309.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$291.19
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.25
|
|
|
PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 11606
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$592.45 |
| Rate for Payer: Aetna Commercial |
$341.92
|
| Rate for Payer: BCBS Complete |
$211.58
|
| Rate for Payer: BCBS Trust/PPO |
$592.45
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Meridian Medicaid |
$211.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.96
|
| Rate for Payer: Priority Health Narrow Network |
$385.96
|
| Rate for Payer: Priority Health SBD |
$385.96
|
| Rate for Payer: UMR Bronson Commercial |
$362.02
|
|
|
PR EXCISION MALIGNANT TUMOR MANDIBLE RADICAL
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 21045
|
| Min. Negotiated Rate |
$99.81 |
| Max. Negotiated Rate |
$1,832.72 |
| Rate for Payer: Aetna Commercial |
$1,587.89
|
| Rate for Payer: BCBS Complete |
$805.14
|
| Rate for Payer: BCBS Trust/PPO |
$99.81
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Cash Price |
$1,740.80
|
| Rate for Payer: Meridian Medicaid |
$805.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$766.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,832.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,832.72
|
| Rate for Payer: Priority Health SBD |
$1,832.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,000.96
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 11600
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$1,866.00 |
| Rate for Payer: Aetna Commercial |
$130.60
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,866.00
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.62
|
| Rate for Payer: Priority Health Narrow Network |
$149.62
|
| Rate for Payer: Priority Health SBD |
$149.62
|
| Rate for Payer: UMR Bronson Commercial |
$143.52
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 11601
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$259.00 |
| Rate for Payer: Aetna Commercial |
$158.43
|
| Rate for Payer: BCBS Complete |
$99.53
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Meridian Medicaid |
$99.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.27
|
| Rate for Payer: Priority Health Narrow Network |
$181.27
|
| Rate for Payer: Priority Health SBD |
$181.27
|
| Rate for Payer: UMR Bronson Commercial |
$170.20
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 11602
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$281.40 |
| Rate for Payer: Aetna Commercial |
$172.05
|
| Rate for Payer: BCBS Complete |
$108.02
|
| Rate for Payer: BCBS Trust/PPO |
$46.61
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$108.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.89
|
| Rate for Payer: Priority Health Narrow Network |
$196.89
|
| Rate for Payer: Priority Health SBD |
$196.89
|
| Rate for Payer: UMR Bronson Commercial |
$184.92
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
11602
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna American Axle |
$261.30
|
| Rate for Payer: Aetna Commercial |
$341.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.30
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$281.40
|
| Rate for Payer: Cofinity Commercial |
$345.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.60
|
| Rate for Payer: Healthscope Commercial |
$361.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.70
|
| Rate for Payer: PHP Commercial |
$341.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health SBD |
$253.26
|
| Rate for Payer: UMR Bronson Commercial |
$176.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.50
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
11602
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$281.40 |
| Rate for Payer: Aetna Commercial |
$172.05
|
| Rate for Payer: BCBS Complete |
$108.02
|
| Rate for Payer: BCBS Trust/PPO |
$46.61
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$108.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.89
|
| Rate for Payer: Priority Health Narrow Network |
$196.89
|
| Rate for Payer: Priority Health SBD |
$196.89
|
| Rate for Payer: UMR Bronson Commercial |
$184.92
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
11602
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$148.74 |
| Max. Negotiated Rate |
$1,115.78 |
| Rate for Payer: Aetna American Axle |
$261.30
|
| Rate for Payer: Aetna Commercial |
$341.70
|
| Rate for Payer: Aetna Medicare |
$368.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$540.45
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$345.72
|
| Rate for Payer: Cofinity Commercial |
$281.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$361.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.50
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.70
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$341.70
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,115.78
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$892.62
|
| Rate for Payer: Priority Health SBD |
$253.26
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.43
|
| Rate for Payer: UHC Exchange |
$158.15
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: UMR Bronson Commercial |
$148.74
|
| Rate for Payer: VA VA |
$354.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.50
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
11603
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$201.52 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Aetna American Axle |
$297.70
|
| Rate for Payer: Aetna Commercial |
$389.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.70
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$320.60
|
| Rate for Payer: Cofinity Commercial |
$393.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.40
|
| Rate for Payer: Healthscope Commercial |
$412.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.30
|
| Rate for Payer: PHP Commercial |
$389.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.60
|
| Rate for Payer: Priority Health SBD |
$288.54
|
| Rate for Payer: UMR Bronson Commercial |
$201.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.50
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
11603
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$169.46 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$297.70
|
| Rate for Payer: Aetna Commercial |
$389.30
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.70
|
| 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 |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$320.60
|
| Rate for Payer: Cofinity Commercial |
$393.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$412.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.50
|
| 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 |
$389.30
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$389.30
|
| 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 |
$320.60
|
| 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 |
$288.54
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$188.93
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$169.46
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.50
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
11603
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$320.60 |
| Rate for Payer: Aetna Commercial |
$205.93
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.93
|
| Rate for Payer: Priority Health Narrow Network |
$235.93
|
| Rate for Payer: Priority Health SBD |
$235.93
|
| Rate for Payer: UMR Bronson Commercial |
$210.68
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 11603
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$320.60 |
| Rate for Payer: Aetna Commercial |
$205.93
|
| Rate for Payer: BCBS Complete |
$129.04
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Meridian Medicaid |
$129.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.93
|
| Rate for Payer: Priority Health Narrow Network |
$235.93
|
| Rate for Payer: Priority Health SBD |
$235.93
|
| Rate for Payer: UMR Bronson Commercial |
$210.68
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 11604
|
| Min. Negotiated Rate |
$135.26 |
| Max. Negotiated Rate |
$5,686.65 |
| Rate for Payer: Aetna Commercial |
$228.37
|
| Rate for Payer: BCBS Complete |
$142.02
|
| Rate for Payer: BCBS Trust/PPO |
$5,686.65
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Meridian Medicaid |
$142.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.78
|
| Rate for Payer: Priority Health Narrow Network |
$259.78
|
| Rate for Payer: Priority Health SBD |
$259.78
|
| Rate for Payer: UMR Bronson Commercial |
$235.06
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 11604
|
| Hospital Charge Code |
11604
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$189.07 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$332.15
|
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.15
|
| 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 |
$1,098.98
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Cofinity Commercial |
$357.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$459.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.25
|
| 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 |
$434.35
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$434.35
|
| 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 |
$357.70
|
| 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 |
$321.93
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$207.93
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$189.07
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.25
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 11604
|
| Hospital Charge Code |
11604
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$224.84 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna American Axle |
$332.15
|
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.15
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$357.70
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.80
|
| Rate for Payer: Healthscope Commercial |
$459.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.35
|
| Rate for Payer: PHP Commercial |
$434.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.70
|
| Rate for Payer: Priority Health SBD |
$321.93
|
| Rate for Payer: UMR Bronson Commercial |
$224.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.25
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
11604
|
| Min. Negotiated Rate |
$135.26 |
| Max. Negotiated Rate |
$5,686.65 |
| Rate for Payer: Aetna Commercial |
$228.37
|
| Rate for Payer: BCBS Complete |
$142.02
|
| Rate for Payer: BCBS Trust/PPO |
$5,686.65
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Meridian Medicaid |
$142.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.78
|
| Rate for Payer: Priority Health Narrow Network |
$259.78
|
| Rate for Payer: Priority Health SBD |
$259.78
|
| Rate for Payer: UMR Bronson Commercial |
$235.06
|
|
|
PR EXCISION MAXILLARY TORUS PALATINUS
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 21032
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$543.90 |
| Rate for Payer: Aetna Commercial |
$350.61
|
| Rate for Payer: BCBS Complete |
$175.57
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Meridian Medicaid |
$175.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$167.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.26
|
| Rate for Payer: Priority Health Narrow Network |
$396.26
|
| Rate for Payer: Priority Health SBD |
$396.26
|
| Rate for Payer: UMR Bronson Commercial |
$357.42
|
|
|
PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 46230
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$1,777.73 |
| Rate for Payer: Aetna Commercial |
$230.39
|
| Rate for Payer: BCBS Complete |
$117.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.73
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Meridian Medicaid |
$117.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.58
|
| Rate for Payer: Priority Health Narrow Network |
$304.58
|
| Rate for Payer: Priority Health SBD |
$304.58
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
|
|
PR EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 11750
|
| Min. Negotiated Rate |
$20.33 |
| Max. Negotiated Rate |
$331.80 |
| Rate for Payer: Aetna Commercial |
$104.27
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS Trust/PPO |
$20.33
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.90
|
| Rate for Payer: Priority Health Narrow Network |
$122.90
|
| Rate for Payer: Priority Health SBD |
$122.90
|
| Rate for Payer: UMR Bronson Commercial |
$218.04
|
|
|
PR EXCISION NASAL POLYP EXTENSIVE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 30115
|
| Min. Negotiated Rate |
$300.54 |
| Max. Negotiated Rate |
$893.36 |
| Rate for Payer: Aetna Commercial |
$587.21
|
| Rate for Payer: BCBS Complete |
$315.57
|
| Rate for Payer: BCBS Trust/PPO |
$893.36
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Meridian Medicaid |
$315.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$300.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$557.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$657.53
|
| Rate for Payer: Priority Health Narrow Network |
$657.53
|
| Rate for Payer: Priority Health SBD |
$657.53
|
| Rate for Payer: UMR Bronson Commercial |
$366.62
|
|
|
PR EXCISION NASAL POLYP SIMPLE
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 30110
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$937.20 |
| Rate for Payer: Aetna Commercial |
$164.52
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS Trust/PPO |
$937.20
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Cash Price |
$389.60
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.29
|
| Rate for Payer: Priority Health Narrow Network |
$184.29
|
| Rate for Payer: Priority Health SBD |
$184.29
|
| Rate for Payer: UMR Bronson Commercial |
$224.02
|
|
|
PR EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
HCPCS 64778
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$303.50 |
| Rate for Payer: Aetna Commercial |
$235.17
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS Trust/PPO |
$291.09
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Cash Price |
$260.80
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.50
|
| Rate for Payer: Priority Health Narrow Network |
$303.50
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: UMR Bronson Commercial |
$149.96
|
|
|
PR EXCISION NEUROMA SCIATIC NERVE
|
Professional
|
Both
|
$3,478.00
|
|
|
Service Code
|
HCPCS 64786
|
| Min. Negotiated Rate |
$154.26 |
| Max. Negotiated Rate |
$2,434.60 |
| Rate for Payer: Aetna Commercial |
$1,308.54
|
| Rate for Payer: BCBS Complete |
$676.55
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: Cash Price |
$2,782.40
|
| Rate for Payer: Cash Price |
$2,782.40
|
| Rate for Payer: Meridian Medicaid |
$676.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$644.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,434.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,703.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,703.77
|
| Rate for Payer: Priority Health SBD |
$1,703.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,599.88
|
|
|
PR EXCISION OF BULBOURETHRAL GLAND
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 53250
|
| Min. Negotiated Rate |
$253.90 |
| Max. Negotiated Rate |
$780.50 |
| Rate for Payer: Aetna Commercial |
$505.90
|
| Rate for Payer: BCBS Complete |
$266.60
|
| Rate for Payer: BCBS Trust/PPO |
$419.47
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Meridian Medicaid |
$266.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$634.91
|
| Rate for Payer: Priority Health Narrow Network |
$634.91
|
| Rate for Payer: Priority Health SBD |
$634.91
|
| Rate for Payer: UMR Bronson Commercial |
$512.90
|
|
