|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
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
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$44.78 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: Aetna Medicare |
$66.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.38
|
| Rate for Payer: BCBS Complete |
$47.02
|
| Rate for Payer: BCBS MAPPO |
$63.50
|
| Rate for Payer: BCBS Trust/PPO |
$208.81
|
| Rate for Payer: BCN Commercial |
$208.81
|
| Rate for Payer: BCN Medicare Advantage |
$63.50
|
| 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: Health Alliance Plan Medicare Advantage |
$63.50
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.50
|
| Rate for Payer: Mclaren Medicaid |
$44.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.67
|
| Rate for Payer: Meridian Medicaid |
$47.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.85
|
| 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: PACE Senior Care Partners |
$60.33
|
| Rate for Payer: PACE SWMI |
$63.50
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: PHP Medicare Advantage |
$63.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$220.98
|
| Rate for Payer: Priority Health Medicare |
$64.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.78
|
| Rate for Payer: Railroad Medicare Medicare |
$63.50
|
| Rate for Payer: UHC Core |
$212.09
|
| Rate for Payer: UHC Exchange |
$63.50
|
| Rate for Payer: UHC Medicaid |
$44.78
|
| Rate for Payer: UHC Medicare Advantage |
$63.50
|
| Rate for Payer: UHCCP Medicaid |
$44.78
|
| Rate for Payer: VA VA |
$63.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: Aetna Medicare |
$73.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.12
|
| Rate for Payer: BCBS Complete |
$52.20
|
| Rate for Payer: BCBS MAPPO |
$70.50
|
| Rate for Payer: BCBS Trust/PPO |
$231.83
|
| Rate for Payer: BCN Commercial |
$231.83
|
| Rate for Payer: BCN Medicare Advantage |
$70.50
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.50
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Mclaren Medicaid |
$49.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.03
|
| Rate for Payer: Meridian Medicaid |
$52.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PACE Senior Care Partners |
$66.97
|
| Rate for Payer: PACE SWMI |
$70.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: PHP Medicare Advantage |
$70.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.34
|
| Rate for Payer: Priority Health Medicare |
$71.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.27
|
| Rate for Payer: Railroad Medicare Medicare |
$70.50
|
| Rate for Payer: UHC Core |
$235.47
|
| Rate for Payer: UHC Exchange |
$70.50
|
| Rate for Payer: UHC Medicaid |
$49.72
|
| Rate for Payer: UHC Medicare Advantage |
$70.50
|
| Rate for Payer: UHCCP Medicaid |
$49.72
|
| Rate for Payer: VA VA |
$70.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$196.27 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$239.70
|
| Rate for Payer: BCBS Trust/PPO |
$232.90
|
| Rate for Payer: BCN Commercial |
$232.90
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$242.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.60
|
| Rate for Payer: Healthscope Commercial |
$253.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.70
|
| Rate for Payer: Nomi Health Commercial |
$231.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PHP Commercial |
$239.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.27
|
| Rate for Payer: UHC Core |
$235.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCN Commercial |
$137.84
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Mclaren Medicaid |
$65.39
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.98
|
| Rate for Payer: UHC Medicaid |
$65.39
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
11402
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$122.94
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCN Commercial |
$137.84
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Mclaren Medicaid |
$65.39
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.98
|
| Rate for Payer: UHC Medicaid |
$65.39
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$59.59 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna Commercial |
$287.30
|
| Rate for Payer: Aetna Medicare |
$87.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.62
|
| Rate for Payer: BCBS Complete |
$62.56
|
| Rate for Payer: BCBS MAPPO |
$84.50
|
| Rate for Payer: BCBS Trust/PPO |
$277.87
|
| Rate for Payer: BCN Commercial |
$277.87
|
| Rate for Payer: BCN Medicare Advantage |
$84.50
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$290.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.50
|
| Rate for Payer: Healthscope Commercial |
$304.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.50
|
| Rate for Payer: Mclaren Medicaid |
$59.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.72
|
| Rate for Payer: Meridian Medicaid |
$62.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: Nomi Health Commercial |
$277.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PACE Senior Care Partners |
$80.28
|
| Rate for Payer: PACE SWMI |
$84.50
|
| Rate for Payer: PHP Commercial |
$287.30
|
| Rate for Payer: PHP Medicare Advantage |
$84.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.06
|
| Rate for Payer: Priority Health Medicare |
$85.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.25
|
| Rate for Payer: Railroad Medicare Medicare |
$84.50
|
| Rate for Payer: UHC Core |
$282.23
|
| Rate for Payer: UHC Exchange |
$84.50
|
| Rate for Payer: UHC Medicaid |
$59.59
|
| Rate for Payer: UHC Medicare Advantage |
$84.50
|
| Rate for Payer: UHCCP Medicaid |
$59.59
|
| Rate for Payer: VA VA |
$84.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$235.25 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna Commercial |
$287.30
|
| Rate for Payer: BCBS Trust/PPO |
$279.15
|
| Rate for Payer: BCN Commercial |
$279.15
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$290.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.40
|
| Rate for Payer: Healthscope Commercial |
$304.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.30
|
| Rate for Payer: Nomi Health Commercial |
$277.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: PHP Commercial |
$287.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$294.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.25
|
| Rate for Payer: UHC Core |
$282.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.50
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Mclaren Medicaid |
$86.48
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.29
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCN Commercial |
$179.46
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Mclaren Medicaid |
$86.48
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$208.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.29
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$174.54
|
| Rate for Payer: Aetna Medicare |
$239.50
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCN Commercial |
$197.53
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Mclaren Medicaid |
$96.92
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$229.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.25
|
| Rate for Payer: UHC Medicaid |
$96.92
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: Aetna Medicare |
$124.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$149.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$149.69
|
| Rate for Payer: BCBS Complete |
$88.66
|
| Rate for Payer: BCBS MAPPO |
$119.75
|
| Rate for Payer: BCBS Trust/PPO |
$393.79
|
| Rate for Payer: BCN Commercial |
$393.79
|
| Rate for Payer: BCN Medicare Advantage |
$119.75
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.75
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.25
|
| Rate for Payer: Mclaren Medicaid |
$84.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.74
|
| Rate for Payer: Meridian Medicaid |
$88.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$131.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$392.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PACE Senior Care Partners |
$113.76
|
| Rate for Payer: PACE SWMI |
$119.75
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: PHP Medicare Advantage |
$119.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$416.73
|
| Rate for Payer: Priority Health Medicare |
$120.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.38
|
| Rate for Payer: Railroad Medicare Medicare |
$119.75
|
| Rate for Payer: UHC Core |
$399.96
|
| Rate for Payer: UHC Exchange |
$119.75
|
| Rate for Payer: UHC Medicaid |
$84.45
|
| Rate for Payer: UHC Medicare Advantage |
$119.75
|
| Rate for Payer: UHCCP Medicaid |
$84.45
|
| Rate for Payer: VA VA |
$119.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.25
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$333.38 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Aetna Commercial |
$407.15
|
| Rate for Payer: BCBS Trust/PPO |
$395.61
|
| Rate for Payer: BCN Commercial |
$395.61
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$411.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.20
|
| Rate for Payer: Healthscope Commercial |
$431.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.15
|
| Rate for Payer: Nomi Health Commercial |
$392.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$416.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.38
|
| Rate for Payer: UHC Core |
$399.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.25
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$174.54
|
| Rate for Payer: Aetna Medicare |
$239.50
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCN Commercial |
$197.53
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Mclaren Medicaid |
$96.92
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$229.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.25
|
| Rate for Payer: UHC Medicaid |
$96.92
|
| Rate for Payer: UHCCP Medicaid |
$96.92
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$507.75 |
| Rate for Payer: Aetna Commercial |
$266.88
|
| Rate for Payer: Aetna Medicare |
$338.50
|
| Rate for Payer: BCBS Complete |
$152.53
|
| Rate for Payer: BCN Commercial |
$296.49
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Mclaren Medicaid |
$145.27
|
| Rate for Payer: Meridian Medicaid |
$152.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$344.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.12
|
| Rate for Payer: UHC Medicaid |
$145.27
|
| Rate for Payer: UHCCP Medicaid |
$145.27
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$471.19 |
| Max. Negotiated Rate |
$609.30 |
| Rate for Payer: Aetna Commercial |
$575.45
|
| Rate for Payer: BCBS Trust/PPO |
$559.13
|
| Rate for Payer: BCN Commercial |
$559.13
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$582.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.60
|
| Rate for Payer: Healthscope Commercial |
$609.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.45
|
| Rate for Payer: Nomi Health Commercial |
$555.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PHP Commercial |
$575.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$588.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$471.19
|
| Rate for Payer: UHC Core |
$565.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.75
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
11406
|
| Min. Negotiated Rate |
$145.27 |
| Max. Negotiated Rate |
$507.75 |
| Rate for Payer: Aetna Commercial |
$266.88
|
| Rate for Payer: Aetna Medicare |
$338.50
|
| Rate for Payer: BCBS Complete |
$152.53
|
| Rate for Payer: BCN Commercial |
$296.49
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Mclaren Medicaid |
$145.27
|
| Rate for Payer: Meridian Medicaid |
$152.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$344.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.12
|
| Rate for Payer: UHC Medicaid |
$145.27
|
| Rate for Payer: UHCCP Medicaid |
$145.27
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$119.36 |
| Max. Negotiated Rate |
$609.30 |
| Rate for Payer: Aetna Commercial |
$575.45
|
| Rate for Payer: Aetna Medicare |
$176.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.56
|
| Rate for Payer: BCBS Complete |
$125.31
|
| Rate for Payer: BCBS MAPPO |
$169.25
|
| Rate for Payer: BCBS Trust/PPO |
$556.56
|
| Rate for Payer: BCN Commercial |
$556.56
|
| Rate for Payer: BCN Medicare Advantage |
$169.25
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$582.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.25
|
| Rate for Payer: Healthscope Commercial |
$609.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.75
|
| Rate for Payer: Mclaren Medicaid |
$119.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.71
|
| Rate for Payer: Meridian Medicaid |
$125.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.45
|
| Rate for Payer: Nomi Health Commercial |
$555.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.75
|
| Rate for Payer: PACE Senior Care Partners |
$160.79
|
| Rate for Payer: PACE SWMI |
$169.25
|
| Rate for Payer: PHP Commercial |
$575.45
|
| Rate for Payer: PHP Medicare Advantage |
$169.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$588.99
|
| Rate for Payer: Priority Health Medicare |
$170.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$471.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.25
|
| Rate for Payer: UHC Core |
$565.29
|
| Rate for Payer: UHC Exchange |
$169.25
|
| Rate for Payer: UHC Medicaid |
$119.36
|
| Rate for Payer: UHC Medicare Advantage |
$169.25
|
| Rate for Payer: UHCCP Medicaid |
$119.36
|
| Rate for Payer: VA VA |
$169.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.75
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$199.06 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna Commercial |
$243.10
|
| Rate for Payer: BCBS Trust/PPO |
$236.21
|
| Rate for Payer: BCN Commercial |
$236.21
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$245.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.80
|
| Rate for Payer: Healthscope Commercial |
$257.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.10
|
| Rate for Payer: Nomi Health Commercial |
$234.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PHP Commercial |
$243.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.06
|
| Rate for Payer: UHC Core |
$238.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$139.29
|
| Rate for Payer: Aetna Medicare |
$143.00
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCN Commercial |
$158.65
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Mclaren Medicaid |
$76.68
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.14
|
| Rate for Payer: UHC Medicaid |
$76.68
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$76.68 |
| Max. Negotiated Rate |
$214.50 |
| Rate for Payer: Aetna Commercial |
$139.29
|
| Rate for Payer: Aetna Medicare |
$143.00
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCN Commercial |
$158.65
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Mclaren Medicaid |
$76.68
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.14
|
| Rate for Payer: UHC Medicaid |
$76.68
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna Commercial |
$243.10
|
| Rate for Payer: Aetna Medicare |
$74.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.38
|
| Rate for Payer: BCBS Complete |
$52.94
|
| Rate for Payer: BCBS MAPPO |
$71.50
|
| Rate for Payer: BCBS Trust/PPO |
$235.12
|
| Rate for Payer: BCN Commercial |
$235.12
|
| Rate for Payer: BCN Medicare Advantage |
$71.50
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$245.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.50
|
| Rate for Payer: Healthscope Commercial |
$257.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.50
|
| Rate for Payer: Mclaren Medicaid |
$50.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.08
|
| Rate for Payer: Meridian Medicaid |
$52.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.10
|
| Rate for Payer: Nomi Health Commercial |
$234.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.50
|
| Rate for Payer: PACE Senior Care Partners |
$67.92
|
| Rate for Payer: PACE SWMI |
$71.50
|
| Rate for Payer: PHP Commercial |
$243.10
|
| Rate for Payer: PHP Medicare Advantage |
$71.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.82
|
| Rate for Payer: Priority Health Medicare |
$72.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.06
|
| Rate for Payer: Railroad Medicare Medicare |
$71.50
|
| Rate for Payer: UHC Core |
$238.81
|
| Rate for Payer: UHC Exchange |
$71.50
|
| Rate for Payer: UHC Medicaid |
$50.42
|
| Rate for Payer: UHC Medicare Advantage |
$71.50
|
| Rate for Payer: UHCCP Medicaid |
$50.42
|
| Rate for Payer: VA VA |
$71.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.50
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$253.34 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna Commercial |
$309.40
|
| Rate for Payer: BCBS Trust/PPO |
$300.63
|
| Rate for Payer: BCN Commercial |
$300.63
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$313.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.20
|
| Rate for Payer: Healthscope Commercial |
$327.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.40
|
| Rate for Payer: Nomi Health Commercial |
$298.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PHP Commercial |
$309.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$316.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.34
|
| Rate for Payer: UHC Core |
$303.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.00
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$154.20
|
| Rate for Payer: Aetna Medicare |
$182.00
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCN Commercial |
$175.54
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Mclaren Medicaid |
$84.14
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$203.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.74
|
| Rate for Payer: UHC Medicaid |
$84.14
|
| Rate for Payer: UHCCP Medicaid |
$84.14
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$84.14 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$154.20
|
| Rate for Payer: Aetna Medicare |
$182.00
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: BCN Commercial |
$175.54
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Mclaren Medicaid |
$84.14
|
| Rate for Payer: Meridian Medicaid |
$88.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$203.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.74
|
| Rate for Payer: UHC Medicaid |
$84.14
|
| Rate for Payer: UHCCP Medicaid |
$84.14
|
|
