|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 11421
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: Aetna Medicare |
$134.50
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCN Commercial |
$129.98
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Mclaren Medicaid |
$63.05
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.87
|
| Rate for Payer: UHC Medicaid |
$63.05
|
| Rate for Payer: UHCCP Medicaid |
$63.05
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
11421
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$187.22 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Aetna Commercial |
$228.65
|
| Rate for Payer: BCBS Trust/PPO |
$222.17
|
| Rate for Payer: BCN Commercial |
$222.17
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$231.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.20
|
| Rate for Payer: Healthscope Commercial |
$242.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.65
|
| Rate for Payer: Nomi Health Commercial |
$220.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.75
|
| Rate for Payer: PHP Commercial |
$228.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$234.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.22
|
| Rate for Payer: UHC Core |
$224.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 11421
|
| Hospital Charge Code |
11421
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Aetna Commercial |
$116.28
|
| Rate for Payer: Aetna Medicare |
$134.50
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCN Commercial |
$129.98
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Mclaren Medicaid |
$63.05
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.87
|
| Rate for Payer: UHC Medicaid |
$63.05
|
| Rate for Payer: UHCCP Medicaid |
$63.05
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
11422
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCN Commercial |
$247.77
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.80
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
11422
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$55.53
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$246.63
|
| Rate for Payer: BCN Commercial |
$246.63
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Mclaren Medicaid |
$52.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: Meridian Medicaid |
$55.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.80
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Exchange |
$75.00
|
| Rate for Payer: UHC Medicaid |
$52.89
|
| Rate for Payer: UHC Medicare Advantage |
$75.00
|
| Rate for Payer: UHCCP Medicaid |
$52.89
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11422
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$143.70
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCN Commercial |
$162.97
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Mclaren Medicaid |
$79.24
|
| Rate for Payer: Meridian Medicaid |
$83.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.15
|
| Rate for Payer: UHC Medicaid |
$79.24
|
| Rate for Payer: UHCCP Medicaid |
$79.24
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
11422
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$143.70
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCN Commercial |
$162.97
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Mclaren Medicaid |
$79.24
|
| Rate for Payer: Meridian Medicaid |
$83.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.15
|
| Rate for Payer: UHC Medicaid |
$79.24
|
| Rate for Payer: UHCCP Medicaid |
$79.24
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
11423
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$72.81 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Aetna Commercial |
$351.05
|
| Rate for Payer: Aetna Medicare |
$107.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.06
|
| Rate for Payer: BCBS Complete |
$76.45
|
| Rate for Payer: BCBS MAPPO |
$103.25
|
| Rate for Payer: BCBS Trust/PPO |
$339.53
|
| Rate for Payer: BCN Commercial |
$339.53
|
| Rate for Payer: BCN Medicare Advantage |
$103.25
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cofinity Commercial |
$355.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.25
|
| Rate for Payer: Healthscope Commercial |
$371.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.75
|
| Rate for Payer: Mclaren Medicaid |
$72.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.41
|
| Rate for Payer: Meridian Medicaid |
$76.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$113.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.05
|
| Rate for Payer: Nomi Health Commercial |
$338.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.75
|
| Rate for Payer: PACE Senior Care Partners |
$98.09
|
| Rate for Payer: PACE SWMI |
$103.25
|
| Rate for Payer: PHP Commercial |
$351.05
|
| Rate for Payer: PHP Medicare Advantage |
$103.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$359.31
|
| Rate for Payer: Priority Health Medicare |
$104.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.45
|
| Rate for Payer: Railroad Medicare Medicare |
$103.25
|
| Rate for Payer: UHC Core |
$344.86
|
| Rate for Payer: UHC Exchange |
$103.25
|
| Rate for Payer: UHC Medicaid |
$72.81
|
| Rate for Payer: UHC Medicare Advantage |
$103.25
|
| Rate for Payer: UHCCP Medicaid |
$72.81
|
| Rate for Payer: VA VA |
$103.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
HCPCS 11423
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$309.75 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$206.50
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCN Commercial |
$188.89
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Mclaren Medicaid |
$91.59
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.24
|
| Rate for Payer: UHC Medicaid |
$91.59
|
| Rate for Payer: UHCCP Medicaid |
$91.59
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
11423
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$287.45 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Aetna Commercial |
$351.05
|
| Rate for Payer: BCBS Trust/PPO |
$341.10
|
| Rate for Payer: BCN Commercial |
$341.10
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cofinity Commercial |
$355.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.40
|
| Rate for Payer: Healthscope Commercial |
$371.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.05
|
| Rate for Payer: Nomi Health Commercial |
$338.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.75
|
| Rate for Payer: PHP Commercial |
$351.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$359.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.45
|
| Rate for Payer: UHC Core |
$344.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
HCPCS 11423
|
| Hospital Charge Code |
11423
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$309.75 |
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$206.50
|
| Rate for Payer: BCBS Complete |
$96.17
|
| Rate for Payer: BCN Commercial |
$188.89
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Cash Price |
$330.40
|
| Rate for Payer: Mclaren Medicaid |
$91.59
|
| Rate for Payer: Meridian Medicaid |
$96.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.24
|
| Rate for Payer: UHC Medicaid |
$91.59
|
| Rate for Payer: UHCCP Medicaid |
$91.59
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 11424
|
| Hospital Charge Code |
11424
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna Commercial |
$189.84
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCN Commercial |
$217.16
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Mclaren Medicaid |
$105.22
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.05
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
11424
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$93.09 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$448.80
|
| Rate for Payer: Aetna Medicare |
$137.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.00
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: BCBS MAPPO |
$132.00
|
| Rate for Payer: BCBS Trust/PPO |
$434.07
|
| Rate for Payer: BCN Commercial |
$434.07
|
| Rate for Payer: BCN Medicare Advantage |
$132.00
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cofinity Commercial |
$454.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$475.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.00
|
| Rate for Payer: Mclaren Medicaid |
$93.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.60
|
| Rate for Payer: Meridian Medicaid |
$97.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.80
|
| Rate for Payer: Nomi Health Commercial |
$432.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.00
|
| Rate for Payer: PACE Senior Care Partners |
$125.40
|
| Rate for Payer: PACE SWMI |
$132.00
|
| Rate for Payer: PHP Commercial |
$448.80
|
| Rate for Payer: PHP Medicare Advantage |
$132.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$459.36
|
| Rate for Payer: Priority Health Medicare |
$133.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$367.49
|
| Rate for Payer: Railroad Medicare Medicare |
$132.00
|
| Rate for Payer: UHC Core |
$440.88
|
| Rate for Payer: UHC Exchange |
$132.00
|
| Rate for Payer: UHC Medicaid |
$93.09
|
| Rate for Payer: UHC Medicare Advantage |
$132.00
|
| Rate for Payer: UHCCP Medicaid |
$93.09
|
| Rate for Payer: VA VA |
$132.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 11424
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna Commercial |
$189.84
|
| Rate for Payer: Aetna Medicare |
$264.00
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCN Commercial |
$217.16
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Mclaren Medicaid |
$105.22
|
| Rate for Payer: Meridian Medicaid |
$110.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$252.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.05
|
| Rate for Payer: UHC Medicaid |
$105.22
|
| Rate for Payer: UHCCP Medicaid |
$105.22
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
11424
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$367.49 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$448.80
|
| Rate for Payer: BCBS Trust/PPO |
$436.08
|
| Rate for Payer: BCN Commercial |
$436.08
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cofinity Commercial |
$454.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.40
|
| Rate for Payer: Healthscope Commercial |
$475.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.80
|
| Rate for Payer: Nomi Health Commercial |
$432.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.00
|
| Rate for Payer: PHP Commercial |
$448.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$459.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$367.49
|
| Rate for Payer: UHC Core |
$440.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.00
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 11426
|
| Hospital Charge Code |
11426
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$545.25 |
| Rate for Payer: Aetna Commercial |
$295.43
|
| Rate for Payer: Aetna Medicare |
$363.50
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCN Commercial |
$320.84
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Mclaren Medicaid |
$156.13
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$545.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$372.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.37
|
| Rate for Payer: UHC Medicaid |
$156.13
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
OP
|
$727.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$128.17 |
| Max. Negotiated Rate |
$654.30 |
| Rate for Payer: Aetna Commercial |
$617.95
|
| Rate for Payer: Aetna Medicare |
$189.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$227.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$227.19
|
| Rate for Payer: BCBS Complete |
$134.57
|
| Rate for Payer: BCBS MAPPO |
$181.75
|
| Rate for Payer: BCBS Trust/PPO |
$597.67
|
| Rate for Payer: BCN Commercial |
$597.67
|
| Rate for Payer: BCN Medicare Advantage |
$181.75
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cofinity Commercial |
$625.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.75
|
| Rate for Payer: Healthscope Commercial |
$654.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$545.25
|
| Rate for Payer: Mclaren Medicaid |
$128.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.84
|
| Rate for Payer: Meridian Medicaid |
$134.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$199.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.95
|
| Rate for Payer: Nomi Health Commercial |
$596.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$545.25
|
| Rate for Payer: PACE Senior Care Partners |
$172.66
|
| Rate for Payer: PACE SWMI |
$181.75
|
| Rate for Payer: PHP Commercial |
$617.95
|
| Rate for Payer: PHP Medicare Advantage |
$181.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$632.49
|
| Rate for Payer: Priority Health Medicare |
$183.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$505.99
|
| Rate for Payer: Railroad Medicare Medicare |
$181.75
|
| Rate for Payer: UHC Core |
$607.04
|
| Rate for Payer: UHC Exchange |
$181.75
|
| Rate for Payer: UHC Medicaid |
$128.17
|
| Rate for Payer: UHC Medicare Advantage |
$181.75
|
| Rate for Payer: UHCCP Medicaid |
$128.17
|
| Rate for Payer: VA VA |
$181.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$545.25
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 11426
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$545.25 |
| Rate for Payer: Aetna Commercial |
$295.43
|
| Rate for Payer: Aetna Medicare |
$363.50
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCN Commercial |
$320.84
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Mclaren Medicaid |
$156.13
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$545.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$372.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.37
|
| Rate for Payer: UHC Medicaid |
$156.13
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Facility
|
IP
|
$727.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
11426
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$505.99 |
| Max. Negotiated Rate |
$654.30 |
| Rate for Payer: Aetna Commercial |
$617.95
|
| Rate for Payer: BCBS Trust/PPO |
$600.43
|
| Rate for Payer: BCN Commercial |
$600.43
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cofinity Commercial |
$625.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$581.60
|
| Rate for Payer: Healthscope Commercial |
$654.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$545.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$617.95
|
| Rate for Payer: Nomi Health Commercial |
$596.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$545.25
|
| Rate for Payer: PHP Commercial |
$617.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$632.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$505.99
|
| Rate for Payer: UHC Core |
$607.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$545.25
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
11400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.62
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS MAPPO |
$52.50
|
| Rate for Payer: BCBS Trust/PPO |
$172.64
|
| Rate for Payer: BCN Commercial |
$172.64
|
| Rate for Payer: BCN Medicare Advantage |
$52.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Mclaren Medicaid |
$37.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.12
|
| Rate for Payer: Meridian Medicaid |
$38.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PACE Senior Care Partners |
$49.88
|
| Rate for Payer: PACE SWMI |
$52.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: PHP Medicare Advantage |
$52.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.70
|
| Rate for Payer: Priority Health Medicare |
$53.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.16
|
| Rate for Payer: Railroad Medicare Medicare |
$52.50
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: UHC Exchange |
$52.50
|
| Rate for Payer: UHC Medicaid |
$37.02
|
| Rate for Payer: UHC Medicare Advantage |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$37.02
|
| Rate for Payer: VA VA |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 11400
|
| Min. Negotiated Rate |
$48.78 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$51.22
|
| Rate for Payer: BCN Commercial |
$100.92
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Mclaren Medicaid |
$48.78
|
| Rate for Payer: Meridian Medicaid |
$51.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.14
|
| Rate for Payer: UHC Medicaid |
$48.78
|
| Rate for Payer: UHCCP Medicaid |
$48.78
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
11400
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$146.16 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: BCBS Trust/PPO |
$173.44
|
| Rate for Payer: BCN Commercial |
$173.44
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.16
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 11400
|
| Hospital Charge Code |
11400
|
| Min. Negotiated Rate |
$48.78 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$51.22
|
| Rate for Payer: BCN Commercial |
$100.92
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Mclaren Medicaid |
$48.78
|
| Rate for Payer: Meridian Medicaid |
$51.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.14
|
| Rate for Payer: UHC Medicaid |
$48.78
|
| Rate for Payer: UHCCP Medicaid |
$48.78
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 11401
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Aetna Commercial |
$111.41
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: BCBS Complete |
$63.29
|
| Rate for Payer: BCN Commercial |
$126.06
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Mclaren Medicaid |
$60.28
|
| Rate for Payer: Meridian Medicaid |
$63.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$146.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.30
|
| Rate for Payer: UHC Medicaid |
$60.28
|
| Rate for Payer: UHCCP Medicaid |
$60.28
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$176.78 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: BCBS Trust/PPO |
$209.78
|
| Rate for Payer: BCN Commercial |
$209.78
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$218.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.90
|
| Rate for Payer: Nomi Health Commercial |
$208.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$220.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.78
|
| Rate for Payer: UHC Core |
$212.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.50
|
|
