|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 11424
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$2,640.00 |
| Rate for Payer: Aetna Commercial |
$189.84
|
| Rate for Payer: BCBS Complete |
$122.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,640.00
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Mclaren Medicaid |
$116.30
|
| Rate for Payer: Meridian Medicaid |
$122.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.67
|
| Rate for Payer: Priority Health Narrow Network |
$218.67
|
| Rate for Payer: Priority Health SBD |
$218.67
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 11426
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$484.40 |
| Rate for Payer: Aetna Commercial |
$295.43
|
| Rate for Payer: BCBS Complete |
$180.26
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Mclaren Medicaid |
$171.68
|
| Rate for Payer: Meridian Medicaid |
$180.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.47
|
| Rate for Payer: Priority Health Narrow Network |
$330.47
|
| Rate for Payer: Priority Health SBD |
$330.47
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$435.96 |
| Max. Negotiated Rate |
$622.80 |
| Rate for Payer: Aetna Commercial |
$588.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.80
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cofinity Commercial |
$484.40
|
| Rate for Payer: Cofinity Commercial |
$595.12
|
| Rate for Payer: Healthscope Commercial |
$622.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$588.20
|
| Rate for Payer: PHP Commercial |
$588.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.40
|
| Rate for Payer: Priority Health SBD |
$435.96
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
11426
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$484.40 |
| Rate for Payer: Aetna Commercial |
$295.43
|
| Rate for Payer: BCBS Complete |
$180.26
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Mclaren Medicaid |
$171.68
|
| Rate for Payer: Meridian Medicaid |
$180.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.47
|
| Rate for Payer: Priority Health Narrow Network |
$330.47
|
| Rate for Payer: Priority Health SBD |
$330.47
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$263.92 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Commercial |
$588.20
|
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,427.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cofinity Commercial |
$595.12
|
| Rate for Payer: Cofinity Commercial |
$484.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$622.80
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$588.20
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Commercial |
$588.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,382.58
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$5,906.06
|
| Rate for Payer: Priority Health SBD |
$435.96
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$263.92
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
11400
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$6,962.48 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$6,962.48
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Mclaren Medicaid |
$54.32
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.17
|
| Rate for Payer: Priority Health Narrow Network |
$103.17
|
| Rate for Payer: Priority Health SBD |
$103.17
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
11400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
11400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$1,937.58 |
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$405.67
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,937.58
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,550.06
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$83.50
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 11400
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$6,962.48 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$6,962.48
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Mclaren Medicaid |
$54.32
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.17
|
| Rate for Payer: Priority Health Narrow Network |
$103.17
|
| Rate for Payer: Priority Health SBD |
$103.17
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.45 |
| Max. Negotiated Rate |
$1,076.20 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$233.21
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Cofinity Commercial |
$169.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.70
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,076.20
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$860.96
|
| Rate for Payer: Priority Health SBD |
$152.46
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$104.45
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
11401
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$5,569.98 |
| Rate for Payer: Aetna Commercial |
$111.41
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$5,569.98
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.30
|
| Rate for Payer: Priority Health Narrow Network |
$130.30
|
| Rate for Payer: Priority Health SBD |
$130.30
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 11401
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$5,569.98 |
| Rate for Payer: Aetna Commercial |
$111.41
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$5,569.98
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.30
|
| Rate for Payer: Priority Health Narrow Network |
$130.30
|
| Rate for Payer: Priority Health SBD |
$130.30
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.70
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health SBD |
$152.46
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.50
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Mclaren Medicaid |
$74.34
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.81
|
| Rate for Payer: Priority Health Narrow Network |
$141.81
|
| Rate for Payer: Priority Health SBD |
$141.81
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
11402
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.50
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Mclaren Medicaid |
$74.34
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.81
|
| Rate for Payer: Priority Health Narrow Network |
$141.81
|
| Rate for Payer: Priority Health SBD |
$141.81
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$169.47 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Aetna Commercial |
$228.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.85
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$188.30
|
| Rate for Payer: Cofinity Commercial |
$231.34
|
| Rate for Payer: Healthscope Commercial |
$242.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.65
|
| Rate for Payer: PHP Commercial |
$228.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health SBD |
$169.47
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$114.28 |
| Max. Negotiated Rate |
$1,937.58 |
| Rate for Payer: Aetna Commercial |
$228.65
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$405.67
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$231.34
|
| Rate for Payer: Cofinity Commercial |
$188.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$242.10
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.65
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$228.65
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,937.58
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,550.06
|
| Rate for Payer: Priority Health SBD |
$169.47
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$114.28
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Mclaren Medicaid |
$96.28
|
| Rate for Payer: Meridian Medicaid |
$101.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.91
|
| Rate for Payer: Priority Health Narrow Network |
$182.91
|
| Rate for Payer: Priority Health SBD |
$182.91
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$1,937.58 |
| Rate for Payer: Aetna Commercial |
$273.70
|
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$405.67
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$276.92
|
| Rate for Payer: Cofinity Commercial |
$225.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$289.80
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Commercial |
$273.70
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,937.58
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,550.06
|
| Rate for Payer: Priority Health SBD |
$202.86
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$148.00
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$273.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.30
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$225.40
|
| Rate for Payer: Cofinity Commercial |
$276.92
|
| Rate for Payer: Healthscope Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: PHP Commercial |
$273.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health SBD |
$202.86
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Mclaren Medicaid |
$96.28
|
| Rate for Payer: Meridian Medicaid |
$101.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.91
|
| Rate for Payer: Priority Health Narrow Network |
$182.91
|
| Rate for Payer: Priority Health SBD |
$182.91
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Aetna Commercial |
$174.54
|
| Rate for Payer: BCBS Complete |
$111.15
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Mclaren Medicaid |
$105.86
|
| Rate for Payer: Meridian Medicaid |
$111.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.82
|
| Rate for Payer: Priority Health Narrow Network |
$201.82
|
| Rate for Payer: Priority Health SBD |
$201.82
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$162.74 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$962.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$392.16
|
| Rate for Payer: Cofinity Commercial |
$319.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$410.40
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.60
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$387.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$287.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$162.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Aetna Commercial |
$174.54
|
| Rate for Payer: BCBS Complete |
$111.15
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Mclaren Medicaid |
$105.86
|
| Rate for Payer: Meridian Medicaid |
$111.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.82
|
| Rate for Payer: Priority Health Narrow Network |
$201.82
|
| Rate for Payer: Priority Health SBD |
$201.82
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$287.28 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.40
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$392.16
|
| Rate for Payer: Healthscope Commercial |
$410.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.60
|
| Rate for Payer: PHP Commercial |
$387.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health SBD |
$287.28
|
|
