|
PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 11642
|
| Hospital Charge Code |
11642
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$375.48 |
| Max. Negotiated Rate |
$536.40 |
| Rate for Payer: Aetna Commercial |
$506.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.40
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$417.20
|
| Rate for Payer: Cofinity Commercial |
$512.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.80
|
| Rate for Payer: Healthscope Commercial |
$536.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.60
|
| Rate for Payer: PHP Commercial |
$506.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.40
|
| Rate for Payer: Priority Health SBD |
$375.48
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 11643
|
| Min. Negotiated Rate |
$216.06 |
| Max. Negotiated Rate |
$484.25 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Aetna Medicare |
$224.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.52
|
| Rate for Payer: BCBS Complete |
$298.00
|
| Rate for Payer: BCBS MAPPO |
$216.06
|
| Rate for Payer: BCN Medicare Advantage |
$216.06
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$311.13
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.06
|
| Rate for Payer: Healthscope Commercial |
$345.70
|
| Rate for Payer: Healthscope Commercial |
$399.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.25
|
| Rate for Payer: Nomi Health Commercial |
$259.27
|
| Rate for Payer: PACE SWMI |
$216.06
|
| Rate for Payer: PHP Medicare Advantage |
$216.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.25
|
| Rate for Payer: Priority Health Medicare |
$216.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.06
|
| Rate for Payer: UHC Medicare Advantage |
$216.06
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
11643
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$469.35 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Aetna Commercial |
$633.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.25
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$521.50
|
| Rate for Payer: Cofinity Commercial |
$640.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$521.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.00
|
| Rate for Payer: Healthscope Commercial |
$670.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.25
|
| Rate for Payer: PHP Commercial |
$633.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.25
|
| Rate for Payer: Priority Health SBD |
$469.35
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 11643
|
| Hospital Charge Code |
11643
|
| Min. Negotiated Rate |
$216.06 |
| Max. Negotiated Rate |
$484.25 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Aetna Medicare |
$224.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.13
|
| Rate for Payer: BCBS Complete |
$298.00
|
| Rate for Payer: BCBS MAPPO |
$216.06
|
| Rate for Payer: BCN Medicare Advantage |
$216.06
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$311.13
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.06
|
| Rate for Payer: Healthscope Commercial |
$345.70
|
| Rate for Payer: Healthscope Commercial |
$399.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.25
|
| Rate for Payer: Nomi Health Commercial |
$259.27
|
| Rate for Payer: PACE SWMI |
$216.06
|
| Rate for Payer: PHP Medicare Advantage |
$216.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.25
|
| Rate for Payer: Priority Health Medicare |
$216.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.06
|
| Rate for Payer: UHC Medicare Advantage |
$216.06
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
11643
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$469.35 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$633.25
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$521.50
|
| Rate for Payer: Cofinity Commercial |
$640.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$521.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$670.50
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.25
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$633.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.25
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$469.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
11644
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$580.86 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$783.70
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$645.40
|
| Rate for Payer: Cofinity Commercial |
$792.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$829.80
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.70
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$783.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$580.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
11644
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$580.86 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Aetna Commercial |
$783.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.30
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$645.40
|
| Rate for Payer: Cofinity Commercial |
$792.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.60
|
| Rate for Payer: Healthscope Commercial |
$829.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.70
|
| Rate for Payer: PHP Commercial |
$783.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health SBD |
$580.86
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
HCPCS 11644
|
| Hospital Charge Code |
11644
|
| Min. Negotiated Rate |
$267.42 |
| Max. Negotiated Rate |
$599.30 |
| Rate for Payer: Aetna Commercial |
$358.34
|
| Rate for Payer: Aetna Medicare |
$278.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.08
|
| Rate for Payer: BCBS Complete |
$368.80
|
| Rate for Payer: BCBS MAPPO |
$267.42
|
| Rate for Payer: BCN Medicare Advantage |
$267.42
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$385.08
|
| Rate for Payer: Cofinity Commercial |
$358.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.42
|
| Rate for Payer: Healthscope Commercial |
$427.87
|
| Rate for Payer: Healthscope Commercial |
$494.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.30
|
| Rate for Payer: Nomi Health Commercial |
$320.90
|
| Rate for Payer: PACE SWMI |
$267.42
|
| Rate for Payer: PHP Medicare Advantage |
$267.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$267.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.42
|
| Rate for Payer: UHC Medicare Advantage |
$267.42
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
HCPCS 11644
|
| Min. Negotiated Rate |
$267.42 |
| Max. Negotiated Rate |
$599.30 |
| Rate for Payer: Aetna Commercial |
$358.34
|
| Rate for Payer: Aetna Medicare |
$278.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.34
|
| Rate for Payer: BCBS Complete |
$368.80
|
| Rate for Payer: BCBS MAPPO |
$267.42
|
| Rate for Payer: BCN Medicare Advantage |
$267.42
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$385.08
|
| Rate for Payer: Cofinity Commercial |
$358.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.42
|
| Rate for Payer: Healthscope Commercial |
$494.73
|
| Rate for Payer: Healthscope Commercial |
$427.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.30
|
| Rate for Payer: Nomi Health Commercial |
$320.90
|
| Rate for Payer: PACE SWMI |
$267.42
|
| Rate for Payer: PHP Medicare Advantage |
$267.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$267.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.42
|
| Rate for Payer: UHC Medicare Advantage |
$267.42
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Facility
|
IP
|
$922.00
|
|
|
Service Code
|
CPT 11646
|
| Hospital Charge Code |
11646
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$580.86 |
| Max. Negotiated Rate |
$829.80 |
| Rate for Payer: Aetna Commercial |
$783.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.30
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$645.40
|
| Rate for Payer: Cofinity Commercial |
$792.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.60
|
| Rate for Payer: Healthscope Commercial |
$829.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.70
|
| Rate for Payer: PHP Commercial |
$783.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health SBD |
$580.86
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 11646
|
| Hospital Charge Code |
11646
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$580.86 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Commercial |
$783.70
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$792.92
|
| Rate for Payer: Cofinity Commercial |
$645.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$829.80
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.70
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$783.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$580.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
HCPCS 11646
|
| Hospital Charge Code |
11646
|
| Min. Negotiated Rate |
$368.80 |
| Max. Negotiated Rate |
$685.05 |
| Rate for Payer: Aetna Commercial |
$496.20
|
| Rate for Payer: Aetna Medicare |
$385.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.23
|
| Rate for Payer: BCBS Complete |
$368.80
|
| Rate for Payer: BCBS MAPPO |
$370.30
|
| Rate for Payer: BCN Medicare Advantage |
$370.30
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$496.20
|
| Rate for Payer: Cofinity Commercial |
$533.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.30
|
| Rate for Payer: Healthscope Commercial |
$685.05
|
| Rate for Payer: Healthscope Commercial |
$592.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.30
|
| Rate for Payer: Nomi Health Commercial |
$444.36
|
| Rate for Payer: PACE SWMI |
$370.30
|
| Rate for Payer: PHP Medicare Advantage |
$370.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$370.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.30
|
| Rate for Payer: UHC Medicare Advantage |
$370.30
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
HCPCS 11646
|
| Min. Negotiated Rate |
$368.80 |
| Max. Negotiated Rate |
$685.05 |
| Rate for Payer: Aetna Commercial |
$496.20
|
| Rate for Payer: Aetna Medicare |
$385.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.20
|
| Rate for Payer: BCBS Complete |
$368.80
|
| Rate for Payer: BCBS MAPPO |
$370.30
|
| Rate for Payer: BCN Medicare Advantage |
$370.30
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cash Price |
$737.60
|
| Rate for Payer: Cofinity Commercial |
$533.23
|
| Rate for Payer: Cofinity Commercial |
$496.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.30
|
| Rate for Payer: Healthscope Commercial |
$592.48
|
| Rate for Payer: Healthscope Commercial |
$685.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.30
|
| Rate for Payer: Nomi Health Commercial |
$444.36
|
| Rate for Payer: PACE SWMI |
$370.30
|
| Rate for Payer: PHP Medicare Advantage |
$370.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.30
|
| Rate for Payer: Priority Health Medicare |
$370.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.30
|
| Rate for Payer: UHC Medicare Advantage |
$370.30
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 11620
|
| Min. Negotiated Rate |
$116.21 |
| Max. Negotiated Rate |
$214.99 |
| Rate for Payer: Aetna Commercial |
$155.72
|
| Rate for Payer: Aetna Medicare |
$120.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.72
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$116.21
|
| Rate for Payer: BCN Medicare Advantage |
$116.21
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$167.34
|
| Rate for Payer: Cofinity Commercial |
$155.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.21
|
| Rate for Payer: Healthscope Commercial |
$214.99
|
| Rate for Payer: Healthscope Commercial |
$185.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.30
|
| Rate for Payer: Nomi Health Commercial |
$139.45
|
| Rate for Payer: PACE SWMI |
$116.21
|
| Rate for Payer: PHP Medicare Advantage |
$116.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Medicare |
$116.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.21
|
| Rate for Payer: UHC Medicare Advantage |
$116.21
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 11621
|
| Min. Negotiated Rate |
$141.47 |
| Max. Negotiated Rate |
$261.72 |
| Rate for Payer: Aetna Commercial |
$189.57
|
| Rate for Payer: Aetna Medicare |
$147.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.57
|
| Rate for Payer: BCBS Complete |
$152.00
|
| Rate for Payer: BCBS MAPPO |
$141.47
|
| Rate for Payer: BCN Medicare Advantage |
$141.47
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Commercial |
$203.72
|
| Rate for Payer: Cofinity Commercial |
$189.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.47
|
| Rate for Payer: Healthscope Commercial |
$226.35
|
| Rate for Payer: Healthscope Commercial |
$261.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.00
|
| Rate for Payer: Nomi Health Commercial |
$169.76
|
| Rate for Payer: PACE SWMI |
$141.47
|
| Rate for Payer: PHP Medicare Advantage |
$141.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.00
|
| Rate for Payer: Priority Health Medicare |
$141.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.47
|
| Rate for Payer: UHC Medicare Advantage |
$141.47
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 11622
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$295.26 |
| Rate for Payer: Aetna Commercial |
$213.86
|
| Rate for Payer: Aetna Medicare |
$165.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.86
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS MAPPO |
$159.60
|
| Rate for Payer: BCN Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$229.82
|
| Rate for Payer: Cofinity Commercial |
$213.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$295.26
|
| Rate for Payer: Healthscope Commercial |
$255.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.60
|
| Rate for Payer: Nomi Health Commercial |
$191.52
|
| Rate for Payer: PACE SWMI |
$159.60
|
| Rate for Payer: PHP Medicare Advantage |
$159.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Medicare |
$159.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.60
|
| Rate for Payer: UHC Medicare Advantage |
$159.60
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM
|
Facility
|
IP
|
$424.00
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
11622
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$267.12 |
| Max. Negotiated Rate |
$381.60 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health SBD |
$267.12
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 11622
|
| Hospital Charge Code |
11622
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$295.26 |
| Rate for Payer: Aetna Commercial |
$213.86
|
| Rate for Payer: Aetna Medicare |
$165.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.82
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS MAPPO |
$159.60
|
| Rate for Payer: BCN Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$213.86
|
| Rate for Payer: Cofinity Commercial |
$229.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.60
|
| Rate for Payer: Healthscope Commercial |
$295.26
|
| Rate for Payer: Healthscope Commercial |
$255.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.60
|
| Rate for Payer: Nomi Health Commercial |
$191.52
|
| Rate for Payer: PACE SWMI |
$159.60
|
| Rate for Payer: PHP Medicare Advantage |
$159.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Medicare |
$159.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.60
|
| Rate for Payer: UHC Medicare Advantage |
$159.60
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM
|
Facility
|
OP
|
$424.00
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
11622
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$267.12 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$360.40
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$364.64
|
| Rate for Payer: Cofinity Commercial |
$296.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$381.60
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.40
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$360.40
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$267.12
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
11623
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$332.01 |
| Max. Negotiated Rate |
$474.30 |
| Rate for Payer: Aetna Commercial |
$447.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.55
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$368.90
|
| Rate for Payer: Cofinity Commercial |
$453.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.60
|
| Rate for Payer: Healthscope Commercial |
$474.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.95
|
| Rate for Payer: PHP Commercial |
$447.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health SBD |
$332.01
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 11623
|
| Min. Negotiated Rate |
$197.99 |
| Max. Negotiated Rate |
$366.28 |
| Rate for Payer: Aetna Commercial |
$265.31
|
| Rate for Payer: Aetna Medicare |
$205.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.31
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$197.99
|
| Rate for Payer: BCN Medicare Advantage |
$197.99
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$285.11
|
| Rate for Payer: Cofinity Commercial |
$265.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.99
|
| Rate for Payer: Healthscope Commercial |
$316.78
|
| Rate for Payer: Healthscope Commercial |
$366.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.55
|
| Rate for Payer: Nomi Health Commercial |
$237.59
|
| Rate for Payer: PACE SWMI |
$197.99
|
| Rate for Payer: PHP Medicare Advantage |
$197.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health Medicare |
$197.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.99
|
| Rate for Payer: UHC Medicare Advantage |
$197.99
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
11623
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$332.01 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$447.95
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$368.90
|
| Rate for Payer: Cofinity Commercial |
$453.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$368.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$474.30
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.95
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$447.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$332.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 11623
|
| Hospital Charge Code |
11623
|
| Min. Negotiated Rate |
$197.99 |
| Max. Negotiated Rate |
$366.28 |
| Rate for Payer: Aetna Commercial |
$265.31
|
| Rate for Payer: Aetna Medicare |
$205.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.11
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$197.99
|
| Rate for Payer: BCN Medicare Advantage |
$197.99
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$285.11
|
| Rate for Payer: Cofinity Commercial |
$265.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.99
|
| Rate for Payer: Healthscope Commercial |
$316.78
|
| Rate for Payer: Healthscope Commercial |
$366.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.55
|
| Rate for Payer: Nomi Health Commercial |
$237.59
|
| Rate for Payer: PACE SWMI |
$197.99
|
| Rate for Payer: PHP Medicare Advantage |
$197.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health Medicare |
$197.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.99
|
| Rate for Payer: UHC Medicare Advantage |
$197.99
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 11624
|
| Min. Negotiated Rate |
$225.44 |
| Max. Negotiated Rate |
$417.06 |
| Rate for Payer: Aetna Commercial |
$302.09
|
| Rate for Payer: Aetna Medicare |
$234.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.09
|
| Rate for Payer: BCBS Complete |
$238.00
|
| Rate for Payer: BCBS MAPPO |
$225.44
|
| Rate for Payer: BCN Medicare Advantage |
$225.44
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$324.63
|
| Rate for Payer: Cofinity Commercial |
$302.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.44
|
| Rate for Payer: Healthscope Commercial |
$417.06
|
| Rate for Payer: Healthscope Commercial |
$360.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.75
|
| Rate for Payer: Nomi Health Commercial |
$270.53
|
| Rate for Payer: PACE SWMI |
$225.44
|
| Rate for Payer: PHP Medicare Advantage |
$225.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.75
|
| Rate for Payer: Priority Health Medicare |
$225.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.44
|
| Rate for Payer: UHC Medicare Advantage |
$225.44
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 11624
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$374.85 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$505.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.75
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$416.50
|
| Rate for Payer: Cofinity Commercial |
$511.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$416.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.00
|
| Rate for Payer: Healthscope Commercial |
$535.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.75
|
| Rate for Payer: PHP Commercial |
$505.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.75
|
| Rate for Payer: Priority Health SBD |
$374.85
|
|
