|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
11402
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare |
$111.94
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$111.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.50
|
| Rate for Payer: BCN Commercial |
$202.61
|
| Rate for Payer: BCN Medicare Advantage |
$111.94
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$150.00
|
| Rate for Payer: Cofinity Commercial |
$161.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.94
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$134.33
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.54
|
| Rate for Payer: PACE SWMI |
$111.94
|
| Rate for Payer: PHP Medicare Advantage |
$111.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.81
|
| Rate for Payer: Priority Health Medicare |
$111.94
|
| Rate for Payer: Priority Health Narrow Network |
$141.81
|
| Rate for Payer: UHC Medicare Advantage |
$115.30
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$188.30 |
| Max. Negotiated Rate |
$269.00 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: ASR ASR |
$260.93
|
| Rate for Payer: BCBS Trust/PPO |
$208.56
|
| Rate for Payer: BCN Commercial |
$208.56
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$252.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.20
|
| Rate for Payer: Healthscope Commercial |
$269.00
|
| Rate for Payer: Healthscope Whirlpool |
$260.93
|
| Rate for Payer: Mclaren Commercial |
$242.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.72
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$1,392.50 |
| Rate for Payer: Aetna Commercial |
$150.00
|
| Rate for Payer: Aetna Medicare |
$111.94
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$111.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.50
|
| Rate for Payer: BCN Commercial |
$202.61
|
| Rate for Payer: BCN Medicare Advantage |
$111.94
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$161.19
|
| Rate for Payer: Cofinity Commercial |
$150.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.94
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Healthscope Whirlpool |
$134.33
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.54
|
| Rate for Payer: PACE SWMI |
$111.94
|
| Rate for Payer: PHP Medicare Advantage |
$111.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.81
|
| Rate for Payer: Priority Health Medicare |
$111.94
|
| Rate for Payer: Priority Health Narrow Network |
$141.81
|
| Rate for Payer: UHC Medicare Advantage |
$115.30
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$193.55
|
| Rate for Payer: Aetna Medicare |
$144.44
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS MAPPO |
$144.44
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$233.24
|
| Rate for Payer: BCN Medicare Advantage |
$144.44
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$207.99
|
| Rate for Payer: Cofinity Commercial |
$193.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.44
|
| Rate for Payer: Healthscope Commercial |
$173.33
|
| Rate for Payer: Healthscope Whirlpool |
$173.33
|
| Rate for Payer: Meridian Medicaid |
$101.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.66
|
| Rate for Payer: PACE SWMI |
$144.44
|
| Rate for Payer: PHP Medicare Advantage |
$144.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.91
|
| Rate for Payer: Priority Health Medicare |
$144.44
|
| Rate for Payer: Priority Health Narrow Network |
$182.91
|
| Rate for Payer: UHC Medicare Advantage |
$148.77
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: ASR ASR |
$312.34
|
| Rate for Payer: BCBS Trust/PPO |
$249.65
|
| Rate for Payer: BCN Commercial |
$249.65
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Healthscope Commercial |
$322.00
|
| Rate for Payer: Healthscope Whirlpool |
$312.34
|
| Rate for Payer: Mclaren Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.36
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$781.74 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$312.34
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$249.65
|
| Rate for Payer: BCN Commercial |
$249.65
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$322.00
|
| Rate for Payer: Healthscope Whirlpool |
$312.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$289.80
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.70
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.02
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$228.62
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.36
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$193.55
|
| Rate for Payer: Aetna Medicare |
$144.44
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS MAPPO |
$144.44
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$233.24
|
| Rate for Payer: BCN Medicare Advantage |
$144.44
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$193.55
|
| Rate for Payer: Cofinity Commercial |
$207.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.44
|
| Rate for Payer: Healthscope Commercial |
$173.33
|
| Rate for Payer: Healthscope Whirlpool |
$173.33
|
| Rate for Payer: Meridian Medicaid |
$101.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.66
|
| Rate for Payer: PACE SWMI |
$144.44
|
| Rate for Payer: PHP Medicare Advantage |
$144.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.91
|
| Rate for Payer: Priority Health Medicare |
$144.44
|
| Rate for Payer: Priority Health Narrow Network |
$182.91
|
| Rate for Payer: UHC Medicare Advantage |
$148.77
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: ASR ASR |
$442.32
|
| Rate for Payer: BCBS Trust/PPO |
$353.54
|
| Rate for Payer: BCN Commercial |
$353.54
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$428.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.80
|
| Rate for Payer: Healthscope Commercial |
$456.00
|
| Rate for Payer: Healthscope Whirlpool |
$442.32
|
| Rate for Payer: Mclaren Commercial |
$410.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.28
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$442.32
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$353.54
|
| Rate for Payer: BCN Commercial |
$353.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$428.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$456.00
|
| Rate for Payer: Healthscope Whirlpool |
$442.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$410.40
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.60
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.96
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$323.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Aetna Commercial |
$214.27
|
| Rate for Payer: Aetna Medicare |
$159.90
|
| Rate for Payer: BCBS Complete |
$111.15
|
| Rate for Payer: BCBS MAPPO |
$159.90
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: BCN Commercial |
$264.65
|
| Rate for Payer: BCN Medicare Advantage |
$159.90
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$230.26
|
| Rate for Payer: Cofinity Commercial |
$214.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.90
|
| Rate for Payer: Healthscope Commercial |
$191.88
|
| Rate for Payer: Healthscope Whirlpool |
$191.88
|
| Rate for Payer: Meridian Medicaid |
$111.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$167.90
|
| Rate for Payer: PACE SWMI |
$159.90
|
| Rate for Payer: PHP Medicare Advantage |
$159.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.82
|
| Rate for Payer: Priority Health Medicare |
$159.90
|
| Rate for Payer: Priority Health Narrow Network |
$201.82
|
| Rate for Payer: UHC Medicare Advantage |
$164.70
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$319.20 |
| Rate for Payer: Aetna Commercial |
$214.27
|
| Rate for Payer: Aetna Medicare |
$159.90
|
| Rate for Payer: BCBS Complete |
$111.15
|
| Rate for Payer: BCBS MAPPO |
$159.90
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: BCN Commercial |
$264.65
|
| Rate for Payer: BCN Medicare Advantage |
$159.90
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$230.26
|
| Rate for Payer: Cofinity Commercial |
$214.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.90
|
| Rate for Payer: Healthscope Commercial |
$191.88
|
| Rate for Payer: Healthscope Whirlpool |
$191.88
|
| Rate for Payer: Meridian Medicaid |
$111.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$167.90
|
| Rate for Payer: PACE SWMI |
$159.90
|
| Rate for Payer: PHP Medicare Advantage |
$159.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.82
|
| Rate for Payer: Priority Health Medicare |
$159.90
|
| Rate for Payer: Priority Health Narrow Network |
$201.82
|
| Rate for Payer: UHC Medicare Advantage |
$164.70
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
11406
|
| Min. Negotiated Rate |
$159.54 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna Commercial |
$324.80
|
| Rate for Payer: Aetna Medicare |
$242.39
|
| Rate for Payer: BCBS Complete |
$167.52
|
| Rate for Payer: BCBS MAPPO |
$242.39
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$375.00
|
| Rate for Payer: BCN Medicare Advantage |
$242.39
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cofinity Commercial |
$349.04
|
| Rate for Payer: Cofinity Commercial |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.39
|
| Rate for Payer: Healthscope Commercial |
$290.87
|
| Rate for Payer: Healthscope Whirlpool |
$290.87
|
| Rate for Payer: Meridian Medicaid |
$167.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$254.51
|
| Rate for Payer: PACE SWMI |
$242.39
|
| Rate for Payer: PHP Medicare Advantage |
$242.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.76
|
| Rate for Payer: Priority Health Medicare |
$242.39
|
| Rate for Payer: Priority Health Narrow Network |
$303.76
|
| Rate for Payer: UHC Medicare Advantage |
$249.66
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$159.54 |
| Max. Negotiated Rate |
$450.80 |
| Rate for Payer: Aetna Commercial |
$324.80
|
| Rate for Payer: Aetna Medicare |
$242.39
|
| Rate for Payer: BCBS Complete |
$167.52
|
| Rate for Payer: BCBS MAPPO |
$242.39
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$375.00
|
| Rate for Payer: BCN Medicare Advantage |
$242.39
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cofinity Commercial |
$349.04
|
| Rate for Payer: Cofinity Commercial |
$324.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.39
|
| Rate for Payer: Healthscope Commercial |
$290.87
|
| Rate for Payer: Healthscope Whirlpool |
$290.87
|
| Rate for Payer: Meridian Medicaid |
$167.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$254.51
|
| Rate for Payer: PACE SWMI |
$242.39
|
| Rate for Payer: PHP Medicare Advantage |
$242.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.76
|
| Rate for Payer: Priority Health Medicare |
$242.39
|
| Rate for Payer: Priority Health Narrow Network |
$303.76
|
| Rate for Payer: UHC Medicare Advantage |
$249.66
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$644.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$450.80 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna Commercial |
$579.60
|
| Rate for Payer: ASR ASR |
$624.68
|
| Rate for Payer: BCBS Trust/PPO |
$499.29
|
| Rate for Payer: BCN Commercial |
$499.29
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cofinity Commercial |
$605.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.20
|
| Rate for Payer: Healthscope Commercial |
$644.00
|
| Rate for Payer: Healthscope Whirlpool |
$624.68
|
| Rate for Payer: Mclaren Commercial |
$579.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$547.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.72
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$644.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$450.80 |
| Max. Negotiated Rate |
$1,801.41 |
| Rate for Payer: Aetna Commercial |
$579.60
|
| Rate for Payer: Aetna Medicare |
$1,441.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: ASR ASR |
$624.68
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$499.29
|
| Rate for Payer: BCN Commercial |
$499.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cofinity Commercial |
$605.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$515.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$644.00
|
| Rate for Payer: Healthscope Whirlpool |
$624.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,441.13
|
| Rate for Payer: Mclaren Commercial |
$579.60
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$547.40
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$1,585.24
|
| Rate for Payer: PHP Medicaid |
$788.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.04
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$457.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$566.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: VA VA |
$1,441.13
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$781.74 |
| Rate for Payer: Aetna Commercial |
$245.70
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$264.81
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$211.66
|
| Rate for Payer: BCN Commercial |
$211.66
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$256.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$273.00
|
| Rate for Payer: Healthscope Whirlpool |
$264.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$245.70
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.05
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.43
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$193.83
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.24
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$245.70
|
| Rate for Payer: ASR ASR |
$264.81
|
| Rate for Payer: BCBS Trust/PPO |
$211.66
|
| Rate for Payer: BCN Commercial |
$211.66
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$256.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.40
|
| Rate for Payer: Healthscope Commercial |
$273.00
|
| Rate for Payer: Healthscope Whirlpool |
$264.81
|
| Rate for Payer: Mclaren Commercial |
$245.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.24
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$205.36 |
| Rate for Payer: Aetna Commercial |
$171.84
|
| Rate for Payer: Aetna Medicare |
$128.24
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$128.24
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: BCN Medicare Advantage |
$128.24
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$171.84
|
| Rate for Payer: Cofinity Commercial |
$184.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.24
|
| Rate for Payer: Healthscope Commercial |
$153.89
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.65
|
| Rate for Payer: PACE SWMI |
$128.24
|
| Rate for Payer: PHP Medicare Advantage |
$128.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.18
|
| Rate for Payer: Priority Health Medicare |
$128.24
|
| Rate for Payer: Priority Health Narrow Network |
$163.18
|
| Rate for Payer: UHC Medicare Advantage |
$132.09
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$205.36 |
| Rate for Payer: Aetna Commercial |
$171.84
|
| Rate for Payer: Aetna Medicare |
$128.24
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$128.24
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: BCN Medicare Advantage |
$128.24
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$184.67
|
| Rate for Payer: Cofinity Commercial |
$171.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.24
|
| Rate for Payer: Healthscope Commercial |
$153.89
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.65
|
| Rate for Payer: PACE SWMI |
$128.24
|
| Rate for Payer: PHP Medicare Advantage |
$128.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.18
|
| Rate for Payer: Priority Health Medicare |
$128.24
|
| Rate for Payer: Priority Health Narrow Network |
$163.18
|
| Rate for Payer: UHC Medicare Advantage |
$132.09
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$781.74 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Medicare |
$625.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: ASR ASR |
$335.62
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$268.25
|
| Rate for Payer: BCN Commercial |
$268.25
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$325.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$346.00
|
| Rate for Payer: Healthscope Whirlpool |
$335.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$625.39
|
| Rate for Payer: Mclaren Commercial |
$311.40
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.10
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$687.93
|
| Rate for Payer: PHP Medicaid |
$342.09
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.86
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$245.66
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.48
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: VA VA |
$625.39
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$346.00 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: ASR ASR |
$335.62
|
| Rate for Payer: BCBS Trust/PPO |
$268.25
|
| Rate for Payer: BCN Commercial |
$268.25
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$325.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.80
|
| Rate for Payer: Healthscope Commercial |
$346.00
|
| Rate for Payer: Healthscope Whirlpool |
$335.62
|
| Rate for Payer: Mclaren Commercial |
$311.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.48
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$242.20 |
| Rate for Payer: Aetna Commercial |
$190.07
|
| Rate for Payer: Aetna Medicare |
$141.84
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: BCBS MAPPO |
$141.84
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: BCN Medicare Advantage |
$141.84
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Cofinity Commercial |
$190.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.84
|
| Rate for Payer: Healthscope Commercial |
$170.21
|
| Rate for Payer: Healthscope Whirlpool |
$170.21
|
| Rate for Payer: Meridian Medicaid |
$99.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.93
|
| Rate for Payer: PACE SWMI |
$141.84
|
| Rate for Payer: PHP Medicare Advantage |
$141.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.04
|
| Rate for Payer: Priority Health Medicare |
$141.84
|
| Rate for Payer: Priority Health Narrow Network |
$180.04
|
| Rate for Payer: UHC Medicare Advantage |
$146.10
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$242.20 |
| Rate for Payer: Aetna Commercial |
$190.07
|
| Rate for Payer: Aetna Medicare |
$141.84
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: BCBS MAPPO |
$141.84
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: BCN Medicare Advantage |
$141.84
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$190.07
|
| Rate for Payer: Cofinity Commercial |
$204.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.84
|
| Rate for Payer: Healthscope Commercial |
$170.21
|
| Rate for Payer: Healthscope Whirlpool |
$170.21
|
| Rate for Payer: Meridian Medicaid |
$99.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.93
|
| Rate for Payer: PACE SWMI |
$141.84
|
| Rate for Payer: PHP Medicare Advantage |
$141.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.04
|
| Rate for Payer: Priority Health Medicare |
$141.84
|
| Rate for Payer: Priority Health Narrow Network |
$180.04
|
| Rate for Payer: UHC Medicare Advantage |
$146.10
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
11443
|
| Min. Negotiated Rate |
$115.02 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$232.26
|
| Rate for Payer: Aetna Medicare |
$173.33
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: BCBS MAPPO |
$173.33
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| Rate for Payer: BCN Medicare Advantage |
$173.33
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$232.26
|
| Rate for Payer: Cofinity Commercial |
$249.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.33
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.00
|
| Rate for Payer: Meridian Medicaid |
$120.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$182.00
|
| Rate for Payer: PACE SWMI |
$173.33
|
| Rate for Payer: PHP Medicare Advantage |
$173.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.09
|
| Rate for Payer: Priority Health Medicare |
$173.33
|
| Rate for Payer: Priority Health Narrow Network |
$219.09
|
| Rate for Payer: UHC Medicare Advantage |
$178.53
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$440.00 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: ASR ASR |
$426.80
|
| Rate for Payer: BCBS Trust/PPO |
$341.13
|
| Rate for Payer: BCN Commercial |
$341.13
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$413.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.00
|
| Rate for Payer: Healthscope Commercial |
$440.00
|
| Rate for Payer: Healthscope Whirlpool |
$426.80
|
| Rate for Payer: Mclaren Commercial |
$396.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.20
|
|
