|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$236.94 |
| Max. Negotiated Rate |
$881.99 |
| Rate for Payer: Aetna Commercial |
$304.20
|
| Rate for Payer: Aetna Medicare |
$705.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: ASR ASR |
$327.86
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$278.68
|
| Rate for Payer: BCN Commercial |
$278.68
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$317.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$327.86
|
| Rate for Payer: Healthscope Whirlpool |
$338.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$705.59
|
| Rate for Payer: Mclaren Commercial |
$304.20
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$387.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: Nomi Health Commercial |
$277.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$776.15
|
| Rate for Payer: PHP Medicaid |
$378.20
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$296.16
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Narrow Network |
$236.94
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP DNSP |
$705.59
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$254.35 |
| Rate for Payer: Aetna Commercial |
$175.29
|
| Rate for Payer: Aetna Medicare |
$130.81
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$130.81
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: BCN Medicare Advantage |
$130.81
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$188.37
|
| Rate for Payer: Cofinity Commercial |
$175.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.81
|
| Rate for Payer: Healthscope Commercial |
$156.97
|
| Rate for Payer: Healthscope Whirlpool |
$156.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.35
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.89
|
| Rate for Payer: Nomi Health Commercial |
$156.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PACE SWMI |
$130.81
|
| Rate for Payer: PHP Medicare Advantage |
$130.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$208.29
|
| Rate for Payer: Priority Health Medicare |
$130.81
|
| Rate for Payer: Priority Health Narrow Network |
$208.29
|
| Rate for Payer: Railroad Medicare Medicare |
$130.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$130.81
|
| Rate for Payer: UHC Exchange |
$254.35
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHCCP DNSP |
$130.81
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$338.00 |
| Rate for Payer: Aetna Commercial |
$304.20
|
| Rate for Payer: ASR ASR |
$327.86
|
| Rate for Payer: BCBS Trust/PPO |
$277.57
|
| Rate for Payer: BCN Commercial |
$277.57
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$317.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Healthscope Commercial |
$327.86
|
| Rate for Payer: Healthscope Whirlpool |
$338.00
|
| Rate for Payer: Mclaren Commercial |
$304.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: Nomi Health Commercial |
$277.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$335.78 |
| Max. Negotiated Rate |
$2,057.07 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$464.63
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$394.94
|
| Rate for Payer: BCN Commercial |
$394.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$450.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$464.63
|
| Rate for Payer: Healthscope Whirlpool |
$479.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$431.10
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$392.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$419.70
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$335.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$197.44
|
| Rate for Payer: Aetna Medicare |
$147.34
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$147.34
|
| Rate for Payer: BCN Commercial |
$197.53
|
| Rate for Payer: BCN Medicare Advantage |
$147.34
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$212.17
|
| Rate for Payer: Cofinity Commercial |
$197.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.34
|
| Rate for Payer: Healthscope Commercial |
$176.81
|
| Rate for Payer: Healthscope Whirlpool |
$176.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.71
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.07
|
| Rate for Payer: Nomi Health Commercial |
$176.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE SWMI |
$147.34
|
| Rate for Payer: PHP Medicare Advantage |
$147.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$229.25
|
| Rate for Payer: Priority Health Medicare |
$147.34
|
| Rate for Payer: Priority Health Narrow Network |
$229.25
|
| Rate for Payer: Railroad Medicare Medicare |
$147.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$147.34
|
| Rate for Payer: UHC Exchange |
$280.87
|
| Rate for Payer: UHC Medicaid |
$96.92
|
| Rate for Payer: UHCCP DNSP |
$147.34
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$197.44
|
| Rate for Payer: Aetna Medicare |
$147.34
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$147.34
|
| Rate for Payer: BCN Commercial |
$197.53
|
| Rate for Payer: BCN Medicare Advantage |
$147.34
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$212.17
|
| Rate for Payer: Cofinity Commercial |
$197.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.34
|
| Rate for Payer: Healthscope Commercial |
$176.81
|
| Rate for Payer: Healthscope Whirlpool |
$176.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.71
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.07
|
| Rate for Payer: Nomi Health Commercial |
$176.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE SWMI |
$147.34
|
| Rate for Payer: PHP Medicare Advantage |
$147.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$229.25
|
| Rate for Payer: Priority Health Medicare |
$147.34
|
| Rate for Payer: Priority Health Narrow Network |
$229.25
|
| Rate for Payer: Railroad Medicare Medicare |
$147.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$147.34
|
| Rate for Payer: UHC Exchange |
$280.87
|
| Rate for Payer: UHC Medicaid |
$96.92
|
| Rate for Payer: UHCCP DNSP |
$147.34
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$359.25 |
| Max. Negotiated Rate |
$479.00 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: ASR ASR |
$464.63
|
| Rate for Payer: BCBS Trust/PPO |
$393.35
|
| Rate for Payer: BCN Commercial |
$393.35
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$450.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Healthscope Commercial |
$464.63
|
| Rate for Payer: Healthscope Whirlpool |
$479.00
|
| Rate for Payer: Mclaren Commercial |
$431.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$392.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$507.75 |
| Rate for Payer: Aetna Commercial |
$298.23
|
| Rate for Payer: Aetna Medicare |
$222.56
|
| Rate for Payer: BCBS Complete |
$152.53
|
| Rate for Payer: BCBS MAPPO |
$222.56
|
| Rate for Payer: BCN Commercial |
$296.49
|
| Rate for Payer: BCN Medicare Advantage |
$222.56
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$320.49
|
| Rate for Payer: Cofinity Commercial |
$298.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.56
|
| Rate for Payer: Healthscope Commercial |
$267.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.69
|
| Rate for Payer: Meridian Medicaid |
$152.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$244.82
|
| Rate for Payer: Nomi Health Commercial |
$267.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PACE SWMI |
$222.56
|
| Rate for Payer: PHP Medicare Advantage |
$222.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$344.12
|
| Rate for Payer: Priority Health Medicare |
$222.56
|
| Rate for Payer: Priority Health Narrow Network |
$344.12
|
| Rate for Payer: Railroad Medicare Medicare |
$222.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$222.56
|
| Rate for Payer: UHC Exchange |
$429.54
|
| Rate for Payer: UHC Medicaid |
$145.27
|
| Rate for Payer: UHCCP DNSP |
$222.56
|
| Rate for Payer: UHCCP Medicaid |
$145.27
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$474.58 |
| Max. Negotiated Rate |
$2,057.07 |
| Rate for Payer: Aetna Commercial |
$609.30
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$656.69
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$558.19
|
| Rate for Payer: BCN Commercial |
$558.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$636.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$656.69
|
| Rate for Payer: Healthscope Whirlpool |
$677.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$609.30
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.45
|
| Rate for Payer: Nomi Health Commercial |
$555.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$593.19
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$474.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$507.75 |
| Max. Negotiated Rate |
$677.00 |
| Rate for Payer: Aetna Commercial |
$609.30
|
| Rate for Payer: ASR ASR |
$656.69
|
| Rate for Payer: BCBS Trust/PPO |
$555.95
|
| Rate for Payer: BCN Commercial |
$555.95
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$636.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.60
|
| Rate for Payer: Healthscope Commercial |
$656.69
|
| Rate for Payer: Healthscope Whirlpool |
$677.00
|
| Rate for Payer: Mclaren Commercial |
$609.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.45
|
| Rate for Payer: Nomi Health Commercial |
$555.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
11406
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$507.75 |
| Rate for Payer: Aetna Commercial |
$298.23
|
| Rate for Payer: Aetna Medicare |
$222.56
|
| Rate for Payer: BCBS Complete |
$152.53
|
| Rate for Payer: BCBS MAPPO |
$222.56
|
| Rate for Payer: BCN Commercial |
$296.49
|
| Rate for Payer: BCN Medicare Advantage |
$222.56
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$320.49
|
| Rate for Payer: Cofinity Commercial |
$298.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.56
|
| Rate for Payer: Healthscope Commercial |
$267.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.69
|
| Rate for Payer: Meridian Medicaid |
$152.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$244.82
|
| Rate for Payer: Nomi Health Commercial |
$267.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PACE SWMI |
$222.56
|
| Rate for Payer: PHP Medicare Advantage |
$222.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$344.12
|
| Rate for Payer: Priority Health Medicare |
$222.56
|
| Rate for Payer: Priority Health Narrow Network |
$344.12
|
| Rate for Payer: Railroad Medicare Medicare |
$222.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$222.56
|
| Rate for Payer: UHC Exchange |
$429.54
|
| Rate for Payer: UHC Medicaid |
$145.27
|
| Rate for Payer: UHCCP DNSP |
$222.56
|
| Rate for Payer: UHCCP Medicaid |
$145.27
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$200.49 |
| Max. Negotiated Rate |
$881.99 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Medicare |
$705.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: ASR ASR |
$277.42
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$235.81
|
| Rate for Payer: BCN Commercial |
$235.81
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$268.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$277.42
|
| Rate for Payer: Healthscope Whirlpool |
$286.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$705.59
|
| Rate for Payer: Mclaren Commercial |
$257.40
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$387.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.10
|
| Rate for Payer: Nomi Health Commercial |
$234.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$776.15
|
| Rate for Payer: PHP Medicaid |
$378.20
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$250.59
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Narrow Network |
$200.49
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP DNSP |
$705.59
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$223.49 |
| Rate for Payer: Aetna Commercial |
$154.74
|
| Rate for Payer: Aetna Medicare |
$115.48
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS MAPPO |
$115.48
|
| Rate for Payer: BCN Commercial |
$158.65
|
| Rate for Payer: BCN Medicare Advantage |
$115.48
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$166.29
|
| Rate for Payer: Cofinity Commercial |
$154.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.48
|
| Rate for Payer: Healthscope Commercial |
$138.58
|
| Rate for Payer: Healthscope Whirlpool |
$138.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.25
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.03
|
| Rate for Payer: Nomi Health Commercial |
$138.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PACE SWMI |
$115.48
|
| Rate for Payer: PHP Medicare Advantage |
$115.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$184.14
|
| Rate for Payer: Priority Health Medicare |
$115.48
|
| Rate for Payer: Priority Health Narrow Network |
$184.14
|
| Rate for Payer: Railroad Medicare Medicare |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.48
|
| Rate for Payer: UHC Exchange |
$223.49
|
| Rate for Payer: UHC Medicaid |
$76.68
|
| Rate for Payer: UHCCP DNSP |
$115.48
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$286.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: ASR ASR |
$277.42
|
| Rate for Payer: BCBS Trust/PPO |
$234.86
|
| Rate for Payer: BCN Commercial |
$234.86
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$268.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.80
|
| Rate for Payer: Healthscope Commercial |
$277.42
|
| Rate for Payer: Healthscope Whirlpool |
$286.00
|
| Rate for Payer: Mclaren Commercial |
$257.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.10
|
| Rate for Payer: Nomi Health Commercial |
$234.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$223.49 |
| Rate for Payer: Aetna Commercial |
$154.74
|
| Rate for Payer: Aetna Medicare |
$115.48
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS MAPPO |
$115.48
|
| Rate for Payer: BCN Commercial |
$158.65
|
| Rate for Payer: BCN Medicare Advantage |
$115.48
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$166.29
|
| Rate for Payer: Cofinity Commercial |
$154.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.48
|
| Rate for Payer: Healthscope Commercial |
$138.58
|
| Rate for Payer: Healthscope Whirlpool |
$138.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.25
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.03
|
| Rate for Payer: Nomi Health Commercial |
$138.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PACE SWMI |
$115.48
|
| Rate for Payer: PHP Medicare Advantage |
$115.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$184.14
|
| Rate for Payer: Priority Health Medicare |
$115.48
|
| Rate for Payer: Priority Health Narrow Network |
$184.14
|
| Rate for Payer: Railroad Medicare Medicare |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.48
|
| Rate for Payer: UHC Exchange |
$223.49
|
| Rate for Payer: UHC Medicaid |
$76.68
|
| Rate for Payer: UHCCP DNSP |
$115.48
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$170.27
|
| Rate for Payer: Aetna Medicare |
$127.07
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$127.07
|
| Rate for Payer: BCN Commercial |
$175.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.07
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$182.98
|
| Rate for Payer: Cofinity Commercial |
$170.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.07
|
| Rate for Payer: Healthscope Commercial |
$152.48
|
| Rate for Payer: Healthscope Whirlpool |
$152.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.42
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.78
|
| Rate for Payer: Nomi Health Commercial |
$152.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE SWMI |
$127.07
|
| Rate for Payer: PHP Medicare Advantage |
$127.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.74
|
| Rate for Payer: Priority Health Medicare |
$127.07
|
| Rate for Payer: Priority Health Narrow Network |
$203.74
|
| Rate for Payer: Railroad Medicare Medicare |
$127.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.07
|
| Rate for Payer: UHC Exchange |
$248.59
|
| Rate for Payer: UHC Medicaid |
$84.14
|
| Rate for Payer: UHCCP DNSP |
$127.07
|
| Rate for Payer: UHCCP Medicaid |
$84.14
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$170.27
|
| Rate for Payer: Aetna Medicare |
$127.07
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCBS MAPPO |
$127.07
|
| Rate for Payer: BCN Commercial |
$175.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.07
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$182.98
|
| Rate for Payer: Cofinity Commercial |
$170.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.07
|
| Rate for Payer: Healthscope Commercial |
$152.48
|
| Rate for Payer: Healthscope Whirlpool |
$152.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.42
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.78
|
| Rate for Payer: Nomi Health Commercial |
$152.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE SWMI |
$127.07
|
| Rate for Payer: PHP Medicare Advantage |
$127.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.74
|
| Rate for Payer: Priority Health Medicare |
$127.07
|
| Rate for Payer: Priority Health Narrow Network |
$203.74
|
| Rate for Payer: Railroad Medicare Medicare |
$127.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$248.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.07
|
| Rate for Payer: UHC Exchange |
$248.59
|
| Rate for Payer: UHC Medicaid |
$84.14
|
| Rate for Payer: UHCCP DNSP |
$127.07
|
| Rate for Payer: UHCCP Medicaid |
$84.14
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$255.16 |
| Max. Negotiated Rate |
$881.99 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Medicare |
$705.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: ASR ASR |
$353.08
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$300.12
|
| Rate for Payer: BCN Commercial |
$300.12
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$342.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$353.08
|
| Rate for Payer: Healthscope Whirlpool |
$364.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$705.59
|
| Rate for Payer: Mclaren Commercial |
$327.60
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$387.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.40
|
| Rate for Payer: Nomi Health Commercial |
$298.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$776.15
|
| Rate for Payer: PHP Medicaid |
$378.20
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$318.94
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Narrow Network |
$255.16
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP DNSP |
$705.59
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: ASR ASR |
$353.08
|
| Rate for Payer: BCBS Trust/PPO |
$298.92
|
| Rate for Payer: BCN Commercial |
$298.92
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$342.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.20
|
| Rate for Payer: Healthscope Commercial |
$353.08
|
| Rate for Payer: Healthscope Whirlpool |
$364.00
|
| Rate for Payer: Mclaren Commercial |
$327.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.40
|
| Rate for Payer: Nomi Health Commercial |
$298.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
11443
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna Commercial |
$206.69
|
| Rate for Payer: Aetna Medicare |
$154.25
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS MAPPO |
$154.25
|
| Rate for Payer: BCN Commercial |
$214.02
|
| Rate for Payer: BCN Medicare Advantage |
$154.25
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$222.12
|
| Rate for Payer: Cofinity Commercial |
$206.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.25
|
| Rate for Payer: Healthscope Commercial |
$185.10
|
| Rate for Payer: Healthscope Whirlpool |
$185.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.96
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$169.68
|
| Rate for Payer: Nomi Health Commercial |
$185.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE SWMI |
$154.25
|
| Rate for Payer: PHP Medicare Advantage |
$154.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$248.40
|
| Rate for Payer: Priority Health Medicare |
$154.25
|
| Rate for Payer: Priority Health Narrow Network |
$248.40
|
| Rate for Payer: Railroad Medicare Medicare |
$154.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$154.25
|
| Rate for Payer: UHC Exchange |
$306.07
|
| Rate for Payer: UHC Medicaid |
$101.60
|
| Rate for Payer: UHCCP DNSP |
$154.25
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$323.86 |
| Max. Negotiated Rate |
$2,057.07 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$448.14
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$380.92
|
| Rate for Payer: BCN Commercial |
$380.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$434.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$448.14
|
| Rate for Payer: Healthscope Whirlpool |
$462.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$415.80
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.70
|
| Rate for Payer: Nomi Health Commercial |
$378.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$404.80
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$323.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$462.00 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: ASR ASR |
$448.14
|
| Rate for Payer: BCBS Trust/PPO |
$379.39
|
| Rate for Payer: BCN Commercial |
$379.39
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$434.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.60
|
| Rate for Payer: Healthscope Commercial |
$448.14
|
| Rate for Payer: Healthscope Whirlpool |
$462.00
|
| Rate for Payer: Mclaren Commercial |
$415.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.70
|
| Rate for Payer: Nomi Health Commercial |
$378.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna Commercial |
$206.69
|
| Rate for Payer: Aetna Medicare |
$154.25
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS MAPPO |
$154.25
|
| Rate for Payer: BCN Commercial |
$214.02
|
| Rate for Payer: BCN Medicare Advantage |
$154.25
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$222.12
|
| Rate for Payer: Cofinity Commercial |
$206.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.25
|
| Rate for Payer: Healthscope Commercial |
$185.10
|
| Rate for Payer: Healthscope Whirlpool |
$185.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.96
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$169.68
|
| Rate for Payer: Nomi Health Commercial |
$185.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE SWMI |
$154.25
|
| Rate for Payer: PHP Medicare Advantage |
$154.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$248.40
|
| Rate for Payer: Priority Health Medicare |
$154.25
|
| Rate for Payer: Priority Health Narrow Network |
$248.40
|
| Rate for Payer: Railroad Medicare Medicare |
$154.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$306.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$154.25
|
| Rate for Payer: UHC Exchange |
$306.07
|
| Rate for Payer: UHC Medicaid |
$101.60
|
| Rate for Payer: UHCCP DNSP |
$154.25
|
| Rate for Payer: UHCCP Medicaid |
$101.60
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$416.39 |
| Max. Negotiated Rate |
$2,057.07 |
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Aetna Medicare |
$1,645.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: ASR ASR |
$576.18
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$489.75
|
| Rate for Payer: BCN Commercial |
$489.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Commercial |
$558.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$576.18
|
| Rate for Payer: Healthscope Whirlpool |
$594.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,645.66
|
| Rate for Payer: Mclaren Commercial |
$534.60
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$903.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.90
|
| Rate for Payer: Nomi Health Commercial |
$487.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,810.23
|
| Rate for Payer: PHP Medicaid |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$520.46
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Narrow Network |
$416.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP DNSP |
$1,645.66
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
HCPCS 11444
|
| Hospital Charge Code |
11444
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$261.03
|
| Rate for Payer: Aetna Medicare |
$194.80
|
| Rate for Payer: BCBS Complete |
$133.97
|
| Rate for Payer: BCBS MAPPO |
$194.80
|
| Rate for Payer: BCN Commercial |
$270.57
|
| Rate for Payer: BCN Medicare Advantage |
$194.80
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cofinity Commercial |
$280.51
|
| Rate for Payer: Cofinity Commercial |
$261.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.80
|
| Rate for Payer: Healthscope Commercial |
$233.76
|
| Rate for Payer: Healthscope Whirlpool |
$233.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.54
|
| Rate for Payer: Meridian Medicaid |
$133.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.28
|
| Rate for Payer: Nomi Health Commercial |
$233.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$445.50
|
| Rate for Payer: PACE SWMI |
$194.80
|
| Rate for Payer: PHP Medicare Advantage |
$194.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$314.04
|
| Rate for Payer: Priority Health Medicare |
$194.80
|
| Rate for Payer: Priority Health Narrow Network |
$314.04
|
| Rate for Payer: Railroad Medicare Medicare |
$194.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$392.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$194.80
|
| Rate for Payer: UHC Exchange |
$392.35
|
| Rate for Payer: UHC Medicaid |
$127.59
|
| Rate for Payer: UHCCP DNSP |
$194.80
|
| Rate for Payer: UHCCP Medicaid |
$127.59
|
|
