|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
11424
|
| Min. Negotiated Rate |
$117.79 |
| Max. Negotiated Rate |
$31,261.00 |
| Rate for Payer: Aetna Commercial |
$232.36
|
| Rate for Payer: Aetna Medicare |
$180.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.70
|
| Rate for Payer: BCBS Complete |
$123.68
|
| Rate for Payer: BCBS MAPPO |
$173.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,640.00
|
| Rate for Payer: BCN Commercial |
$277.61
|
| Rate for Payer: BCN Medicare Advantage |
$173.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$232.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.40
|
| Rate for Payer: Healthscope Commercial |
$320.79
|
| Rate for Payer: Healthscope Commercial |
$277.44
|
| Rate for Payer: Mclaren Medicaid |
$117.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.07
|
| Rate for Payer: Meridian Medicaid |
$123.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,261.00
|
| Rate for Payer: Nomi Health Commercial |
$208.08
|
| Rate for Payer: PACE SWMI |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$173.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.53
|
| Rate for Payer: Priority Health Medicare |
$173.40
|
| Rate for Payer: Priority Health Narrow Network |
$246.53
|
| Rate for Payer: Priority Health SBD |
$246.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.40
|
| Rate for Payer: UHC Exchange |
$226.64
|
| Rate for Payer: UHC Medicare Advantage |
$173.40
|
| Rate for Payer: UHCCP Medicaid |
$117.79
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
11424
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$190.60 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.84
|
| Rate for Payer: BCN Commercial |
$1,321.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$441.18
|
| Rate for Payer: Cofinity Commercial |
$359.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$461.70
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.05
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$436.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$323.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.60
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
11424
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$323.19 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna Commercial |
$436.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.45
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$359.10
|
| Rate for Payer: Cofinity Commercial |
$441.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.40
|
| Rate for Payer: Healthscope Commercial |
$461.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.05
|
| Rate for Payer: PHP Commercial |
$436.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health SBD |
$323.19
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
11426
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$47,551.00 |
| Rate for Payer: Aetna Commercial |
$345.65
|
| Rate for Payer: Aetna Medicare |
$268.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.45
|
| Rate for Payer: BCBS Complete |
$182.72
|
| Rate for Payer: BCBS MAPPO |
$257.95
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$388.74
|
| Rate for Payer: BCN Medicare Advantage |
$257.95
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$371.45
|
| Rate for Payer: Cofinity Commercial |
$345.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.95
|
| Rate for Payer: Healthscope Commercial |
$477.21
|
| Rate for Payer: Healthscope Commercial |
$412.72
|
| Rate for Payer: Mclaren Medicaid |
$174.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.85
|
| Rate for Payer: Meridian Medicaid |
$182.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,551.00
|
| Rate for Payer: Nomi Health Commercial |
$309.54
|
| Rate for Payer: PACE SWMI |
$257.95
|
| Rate for Payer: PHP Medicare Advantage |
$257.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.93
|
| Rate for Payer: Priority Health Medicare |
$257.95
|
| Rate for Payer: Priority Health Narrow Network |
$363.93
|
| Rate for Payer: Priority Health SBD |
$363.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.95
|
| Rate for Payer: UHC Exchange |
$332.07
|
| Rate for Payer: UHC Medicare Advantage |
$257.95
|
| Rate for Payer: UHCCP Medicaid |
$174.02
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$283.52 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Commercial |
$600.10
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.57
|
| Rate for Payer: BCN Commercial |
$1,469.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$607.16
|
| Rate for Payer: Cofinity Commercial |
$494.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$494.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$635.40
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.10
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$600.10
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$444.78
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.52
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$444.78 |
| Max. Negotiated Rate |
$635.40 |
| Rate for Payer: Aetna Commercial |
$600.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.90
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$494.20
|
| Rate for Payer: Cofinity Commercial |
$607.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$494.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.80
|
| Rate for Payer: Healthscope Commercial |
$635.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.10
|
| Rate for Payer: PHP Commercial |
$600.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health SBD |
$444.78
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$706.00
|
|
|
Service Code
|
HCPCS 11426
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$47,551.00 |
| Rate for Payer: Aetna Commercial |
$345.65
|
| Rate for Payer: Aetna Medicare |
$268.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.45
|
| Rate for Payer: BCBS Complete |
$182.72
|
| Rate for Payer: BCBS MAPPO |
$257.95
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$388.74
|
| Rate for Payer: BCN Medicare Advantage |
$257.95
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cofinity Commercial |
$371.45
|
| Rate for Payer: Cofinity Commercial |
$345.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.95
|
| Rate for Payer: Healthscope Commercial |
$477.21
|
| Rate for Payer: Healthscope Commercial |
$412.72
|
| Rate for Payer: Mclaren Medicaid |
$174.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.85
|
| Rate for Payer: Meridian Medicaid |
$182.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,551.00
|
| Rate for Payer: Nomi Health Commercial |
$309.54
|
| Rate for Payer: PACE SWMI |
$257.95
|
| Rate for Payer: PHP Medicare Advantage |
$257.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.93
|
| Rate for Payer: Priority Health Medicare |
$257.95
|
| Rate for Payer: Priority Health Narrow Network |
$363.93
|
| Rate for Payer: Priority Health SBD |
$363.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.95
|
| Rate for Payer: UHC Exchange |
$332.07
|
| Rate for Payer: UHC Medicare Advantage |
$257.95
|
| Rate for Payer: UHCCP Medicaid |
$174.02
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 11400
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$14,557.00 |
| Rate for Payer: Aetna Commercial |
$106.42
|
| Rate for Payer: Aetna Medicare |
$82.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.36
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS MAPPO |
$79.42
|
| Rate for Payer: BCBS Trust/PPO |
$6,962.48
|
| Rate for Payer: BCN Commercial |
$151.17
|
| Rate for Payer: BCN Medicare Advantage |
$79.42
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$114.36
|
| Rate for Payer: Cofinity Commercial |
$106.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.42
|
| Rate for Payer: Healthscope Commercial |
$146.93
|
| Rate for Payer: Healthscope Commercial |
$127.07
|
| Rate for Payer: Mclaren Medicaid |
$54.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.39
|
| Rate for Payer: Meridian Medicaid |
$57.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,557.00
|
| Rate for Payer: Nomi Health Commercial |
$95.30
|
| Rate for Payer: PACE SWMI |
$79.42
|
| Rate for Payer: PHP Medicare Advantage |
$79.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.13
|
| Rate for Payer: Priority Health Medicare |
$79.42
|
| Rate for Payer: Priority Health Narrow Network |
$115.13
|
| Rate for Payer: Priority Health SBD |
$115.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.42
|
| Rate for Payer: UHC Exchange |
$115.57
|
| Rate for Payer: UHC Medicare Advantage |
$79.42
|
| Rate for Payer: UHCCP Medicaid |
$54.74
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
11400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$128.52 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health SBD |
$128.52
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
11400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Cofinity Commercial |
$142.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.40
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$128.52
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.69
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
11400
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$14,557.00 |
| Rate for Payer: Aetna Commercial |
$106.42
|
| Rate for Payer: Aetna Medicare |
$82.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.36
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS MAPPO |
$79.42
|
| Rate for Payer: BCBS Trust/PPO |
$6,962.48
|
| Rate for Payer: BCN Commercial |
$151.17
|
| Rate for Payer: BCN Medicare Advantage |
$79.42
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$114.36
|
| Rate for Payer: Cofinity Commercial |
$106.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.42
|
| Rate for Payer: Healthscope Commercial |
$146.93
|
| Rate for Payer: Healthscope Commercial |
$127.07
|
| Rate for Payer: Mclaren Medicaid |
$54.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.39
|
| Rate for Payer: Meridian Medicaid |
$57.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,557.00
|
| Rate for Payer: Nomi Health Commercial |
$95.30
|
| Rate for Payer: PACE SWMI |
$79.42
|
| Rate for Payer: PHP Medicare Advantage |
$79.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.13
|
| Rate for Payer: Priority Health Medicare |
$79.42
|
| Rate for Payer: Priority Health Narrow Network |
$115.13
|
| Rate for Payer: Priority Health SBD |
$115.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.42
|
| Rate for Payer: UHC Exchange |
$115.57
|
| Rate for Payer: UHC Medicare Advantage |
$79.42
|
| Rate for Payer: UHCCP Medicaid |
$54.74
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 11401
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$18,491.00 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Aetna Medicare |
$103.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.47
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$99.63
|
| Rate for Payer: BCBS Trust/PPO |
$5,569.98
|
| Rate for Payer: BCN Commercial |
$184.56
|
| Rate for Payer: BCN Medicare Advantage |
$99.63
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$133.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.63
|
| Rate for Payer: Healthscope Commercial |
$184.32
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Mclaren Medicaid |
$68.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.61
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,491.00
|
| Rate for Payer: Nomi Health Commercial |
$119.56
|
| Rate for Payer: PACE SWMI |
$99.63
|
| Rate for Payer: PHP Medicare Advantage |
$99.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.04
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: Priority Health Narrow Network |
$144.04
|
| Rate for Payer: Priority Health SBD |
$144.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.63
|
| Rate for Payer: UHC Exchange |
$134.96
|
| Rate for Payer: UHC Medicare Advantage |
$99.63
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
11401
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$18,491.00 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Aetna Medicare |
$103.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.47
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$99.63
|
| Rate for Payer: BCBS Trust/PPO |
$5,569.98
|
| Rate for Payer: BCN Commercial |
$184.56
|
| Rate for Payer: BCN Medicare Advantage |
$99.63
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$133.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.63
|
| Rate for Payer: Healthscope Commercial |
$184.32
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Mclaren Medicaid |
$68.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.61
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,491.00
|
| Rate for Payer: Nomi Health Commercial |
$119.56
|
| Rate for Payer: PACE SWMI |
$99.63
|
| Rate for Payer: PHP Medicare Advantage |
$99.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.04
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: Priority Health Narrow Network |
$144.04
|
| Rate for Payer: Priority Health SBD |
$144.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.63
|
| Rate for Payer: UHC Exchange |
$134.96
|
| Rate for Payer: UHC Medicare Advantage |
$99.63
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$240.15
|
| Rate for Payer: BCN Commercial |
$240.15
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$155.61
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.29
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.55
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Cofinity Commercial |
$212.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: PHP Commercial |
$209.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health SBD |
$155.61
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$20,149.00 |
| Rate for Payer: Aetna Commercial |
$146.23
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.15
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$109.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.50
|
| Rate for Payer: BCN Commercial |
$202.61
|
| Rate for Payer: BCN Medicare Advantage |
$109.13
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Commercial |
$146.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.13
|
| Rate for Payer: Healthscope Commercial |
$201.89
|
| Rate for Payer: Healthscope Commercial |
$174.61
|
| Rate for Payer: Mclaren Medicaid |
$74.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.59
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,149.00
|
| Rate for Payer: Nomi Health Commercial |
$130.96
|
| Rate for Payer: PACE SWMI |
$109.13
|
| Rate for Payer: PHP Medicare Advantage |
$109.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.57
|
| Rate for Payer: Priority Health Medicare |
$109.13
|
| Rate for Payer: Priority Health Narrow Network |
$157.57
|
| Rate for Payer: Priority Health SBD |
$157.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.13
|
| Rate for Payer: UHC Exchange |
$154.36
|
| Rate for Payer: UHC Medicare Advantage |
$109.13
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$120.96 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$235.64
|
| Rate for Payer: Cofinity Commercial |
$191.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$246.60
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$232.90
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$172.62
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.96
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$172.62 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna Commercial |
$232.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$235.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Healthscope Commercial |
$246.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: PHP Commercial |
$232.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health SBD |
$172.62
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
11402
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$20,149.00 |
| Rate for Payer: Aetna Commercial |
$146.23
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.15
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$109.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.50
|
| Rate for Payer: BCN Commercial |
$202.61
|
| Rate for Payer: BCN Medicare Advantage |
$109.13
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Commercial |
$146.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.13
|
| Rate for Payer: Healthscope Commercial |
$201.89
|
| Rate for Payer: Healthscope Commercial |
$174.61
|
| Rate for Payer: Mclaren Medicaid |
$74.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.59
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,149.00
|
| Rate for Payer: Nomi Health Commercial |
$130.96
|
| Rate for Payer: PACE SWMI |
$109.13
|
| Rate for Payer: PHP Medicare Advantage |
$109.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.57
|
| Rate for Payer: Priority Health Medicare |
$109.13
|
| Rate for Payer: Priority Health Narrow Network |
$157.57
|
| Rate for Payer: Priority Health SBD |
$157.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.13
|
| Rate for Payer: UHC Exchange |
$154.36
|
| Rate for Payer: UHC Medicare Advantage |
$109.13
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$206.64 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health SBD |
$206.64
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$25,999.00 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$148.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.97
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$233.24
|
| Rate for Payer: BCN Medicare Advantage |
$142.34
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$204.97
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.34
|
| Rate for Payer: Healthscope Commercial |
$263.33
|
| Rate for Payer: Healthscope Commercial |
$227.74
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.46
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,999.00
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: PACE SWMI |
$142.34
|
| Rate for Payer: PHP Medicare Advantage |
$142.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.09
|
| Rate for Payer: Priority Health Medicare |
$142.34
|
| Rate for Payer: Priority Health Narrow Network |
$204.09
|
| Rate for Payer: Priority Health SBD |
$204.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Exchange |
$174.14
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$156.76 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$417.74
|
| Rate for Payer: BCN Commercial |
$417.74
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.76
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$388.11
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$25,999.00 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$148.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.97
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$233.24
|
| Rate for Payer: BCN Medicare Advantage |
$142.34
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$204.97
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.34
|
| Rate for Payer: Healthscope Commercial |
$263.33
|
| Rate for Payer: Healthscope Commercial |
$227.74
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.46
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,999.00
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: PACE SWMI |
$142.34
|
| Rate for Payer: PHP Medicare Advantage |
$142.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.09
|
| Rate for Payer: Priority Health Medicare |
$142.34
|
| Rate for Payer: Priority Health Narrow Network |
$204.09
|
| Rate for Payer: Priority Health SBD |
$204.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Exchange |
$174.14
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$418.50 |
| Rate for Payer: Aetna Commercial |
$395.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.25
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$325.50
|
| Rate for Payer: Cofinity Commercial |
$399.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.00
|
| Rate for Payer: Healthscope Commercial |
$418.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.25
|
| Rate for Payer: PHP Commercial |
$395.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health SBD |
$292.95
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$28,782.00 |
| Rate for Payer: Aetna Commercial |
$210.85
|
| Rate for Payer: Aetna Medicare |
$163.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.58
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS MAPPO |
$157.35
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: BCN Commercial |
$264.65
|
| Rate for Payer: BCN Medicare Advantage |
$157.35
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$226.58
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.35
|
| Rate for Payer: Healthscope Commercial |
$291.10
|
| Rate for Payer: Healthscope Commercial |
$251.76
|
| Rate for Payer: Mclaren Medicaid |
$107.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.22
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,782.00
|
| Rate for Payer: Nomi Health Commercial |
$188.82
|
| Rate for Payer: PACE SWMI |
$157.35
|
| Rate for Payer: PHP Medicare Advantage |
$157.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.41
|
| Rate for Payer: Priority Health Medicare |
$157.35
|
| Rate for Payer: Priority Health Narrow Network |
$224.41
|
| Rate for Payer: Priority Health SBD |
$224.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.35
|
| Rate for Payer: UHC Exchange |
$202.35
|
| Rate for Payer: UHC Medicare Advantage |
$157.35
|
| Rate for Payer: UHCCP Medicaid |
$107.14
|
|
