|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: Aetna Medicare |
$164.00
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$233.24
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.09
|
| Rate for Payer: Priority Health Narrow Network |
$204.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.95
|
| Rate for Payer: UHC Exchange |
$147.95
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$1,068.51 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$268.60
|
| Rate for Payer: BCN Commercial |
$254.30
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$308.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.39
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$229.93
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 11403
|
| Hospital Charge Code |
11403
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$157.67
|
| Rate for Payer: Aetna Medicare |
$164.00
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$233.24
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.09
|
| Rate for Payer: Priority Health Narrow Network |
$204.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.95
|
| Rate for Payer: UHC Exchange |
$147.95
|
| Rate for Payer: UHCCP Medicaid |
$97.34
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$418.50
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$451.05
|
| Rate for Payer: ASR Commercial |
$451.05
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$380.79
|
| Rate for Payer: BCN Commercial |
$360.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$437.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$465.00
|
| Rate for Payer: Healthscope Whirlpool |
$451.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$418.50
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.25
|
| Rate for Payer: Nomi Health Commercial |
$381.30
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.43
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$325.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$409.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
11404
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$418.50
|
| Rate for Payer: ASR ASR |
$451.05
|
| Rate for Payer: ASR Commercial |
$451.05
|
| Rate for Payer: BCBS Trust/PPO |
$378.93
|
| Rate for Payer: BCN Commercial |
$360.51
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$437.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.00
|
| Rate for Payer: Healthscope Commercial |
$465.00
|
| Rate for Payer: Healthscope Whirlpool |
$451.05
|
| Rate for Payer: Mclaren Commercial |
$418.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.25
|
| Rate for Payer: Nomi Health Commercial |
$381.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$409.20
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$174.54
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: BCN Commercial |
$264.65
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.41
|
| Rate for Payer: Priority Health Narrow Network |
$224.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.56
|
| Rate for Payer: UHC Exchange |
$164.56
|
| Rate for Payer: UHCCP Medicaid |
$107.14
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 11404
|
| Hospital Charge Code |
11404
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$174.54
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$302.17
|
| Rate for Payer: BCN Commercial |
$264.65
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Meridian Medicaid |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.41
|
| Rate for Payer: Priority Health Narrow Network |
$224.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.56
|
| Rate for Payer: UHC Exchange |
$164.56
|
| Rate for Payer: UHCCP Medicaid |
$107.14
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$160.82 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$266.88
|
| Rate for Payer: Aetna Medicare |
$328.50
|
| Rate for Payer: BCBS Complete |
$168.86
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$375.00
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Meridian Medicaid |
$168.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.18
|
| Rate for Payer: Priority Health Narrow Network |
$338.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.14
|
| Rate for Payer: UHC Exchange |
$250.14
|
| Rate for Payer: UHCCP Medicaid |
$160.82
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 11406
|
| Hospital Charge Code |
11406
|
| Min. Negotiated Rate |
$160.82 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$266.88
|
| Rate for Payer: Aetna Medicare |
$328.50
|
| Rate for Payer: BCBS Complete |
$168.86
|
| Rate for Payer: BCBS Trust/PPO |
$201.42
|
| Rate for Payer: BCN Commercial |
$375.00
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Meridian Medicaid |
$168.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.18
|
| Rate for Payer: Priority Health Narrow Network |
$338.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.14
|
| Rate for Payer: UHC Exchange |
$250.14
|
| Rate for Payer: UHCCP Medicaid |
$160.82
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$427.05 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$637.29
|
| Rate for Payer: ASR Commercial |
$637.29
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$538.02
|
| Rate for Payer: BCN Commercial |
$509.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$617.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$657.00
|
| Rate for Payer: Healthscope Whirlpool |
$637.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$591.30
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Nomi Health Commercial |
$538.74
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$575.66
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$460.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
11406
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$427.05 |
| Max. Negotiated Rate |
$657.00 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: ASR ASR |
$637.29
|
| Rate for Payer: ASR Commercial |
$637.29
|
| Rate for Payer: BCBS Trust/PPO |
$535.39
|
| Rate for Payer: BCN Commercial |
$509.37
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$617.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.60
|
| Rate for Payer: Healthscope Commercial |
$657.00
|
| Rate for Payer: Healthscope Whirlpool |
$637.29
|
| Rate for Payer: Mclaren Commercial |
$591.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Nomi Health Commercial |
$538.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.16
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 11441
|
| Hospital Charge Code |
11441
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$205.36 |
| Rate for Payer: Aetna Commercial |
$139.29
|
| Rate for Payer: Aetna Medicare |
$139.00
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.96
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.56
|
| Rate for Payer: UHC Exchange |
$133.56
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$205.36 |
| Rate for Payer: Aetna Commercial |
$139.29
|
| Rate for Payer: Aetna Medicare |
$139.00
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS Trust/PPO |
$185.19
|
| Rate for Payer: BCN Commercial |
$205.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.96
|
| Rate for Payer: Priority Health Narrow Network |
$181.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.56
|
| Rate for Payer: UHC Exchange |
$133.56
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$1,068.51 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$269.66
|
| Rate for Payer: ASR Commercial |
$269.66
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$227.65
|
| Rate for Payer: BCN Commercial |
$215.53
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$261.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$278.00
|
| Rate for Payer: Healthscope Whirlpool |
$269.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$250.20
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$227.96
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.58
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$194.88
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 11441
|
| Hospital Charge Code |
11441
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: ASR ASR |
$269.66
|
| Rate for Payer: ASR Commercial |
$269.66
|
| Rate for Payer: BCBS Trust/PPO |
$226.54
|
| Rate for Payer: BCN Commercial |
$215.53
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$261.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Healthscope Commercial |
$278.00
|
| Rate for Payer: Healthscope Whirlpool |
$269.66
|
| Rate for Payer: Mclaren Commercial |
$250.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$227.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.64
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$229.45 |
| Rate for Payer: Aetna Commercial |
$154.20
|
| Rate for Payer: Aetna Medicare |
$176.50
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.48
|
| Rate for Payer: Priority Health Narrow Network |
$200.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.52
|
| Rate for Payer: UHC Exchange |
$148.52
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 11442
|
| Hospital Charge Code |
11442
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$229.45 |
| Rate for Payer: Aetna Commercial |
$154.20
|
| Rate for Payer: Aetna Medicare |
$176.50
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$228.13
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.48
|
| Rate for Payer: Priority Health Narrow Network |
$200.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.52
|
| Rate for Payer: UHC Exchange |
$148.52
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.45 |
| Max. Negotiated Rate |
$353.00 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: ASR ASR |
$342.41
|
| Rate for Payer: ASR Commercial |
$342.41
|
| Rate for Payer: BCBS Trust/PPO |
$287.66
|
| Rate for Payer: BCN Commercial |
$273.68
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$331.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.40
|
| Rate for Payer: Healthscope Commercial |
$353.00
|
| Rate for Payer: Healthscope Whirlpool |
$342.41
|
| Rate for Payer: Mclaren Commercial |
$317.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.05
|
| Rate for Payer: Nomi Health Commercial |
$289.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.64
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 11442
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$229.45 |
| Max. Negotiated Rate |
$1,068.51 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Aetna Medicare |
$689.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: ASR ASR |
$342.41
|
| Rate for Payer: ASR Commercial |
$342.41
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$289.07
|
| Rate for Payer: BCN Commercial |
$273.68
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$331.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$353.00
|
| Rate for Payer: Healthscope Whirlpool |
$342.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$317.70
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.05
|
| Rate for Payer: Nomi Health Commercial |
$289.46
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Commercial |
$758.30
|
| Rate for Payer: PHP Medicaid |
$369.50
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.30
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$247.45
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$1,068.51
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP DNSP |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 11443
|
| Hospital Charge Code |
11443
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Aetna Commercial |
$189.95
|
| Rate for Payer: Aetna Medicare |
$224.50
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.82
|
| Rate for Payer: Priority Health Narrow Network |
$243.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.69
|
| Rate for Payer: UHC Exchange |
$183.69
|
| Rate for Payer: UHCCP Medicaid |
$116.09
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$291.85 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$404.10
|
| Rate for Payer: Aetna Medicare |
$1,587.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: ASR ASR |
$435.53
|
| Rate for Payer: ASR Commercial |
$435.53
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$367.69
|
| Rate for Payer: BCN Commercial |
$348.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$422.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$449.00
|
| Rate for Payer: Healthscope Whirlpool |
$435.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$404.10
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.65
|
| Rate for Payer: Nomi Health Commercial |
$368.18
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,746.23
|
| Rate for Payer: PHP Medicaid |
$850.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$314.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$2,460.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP DNSP |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
11443
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$291.85 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: Aetna Commercial |
$404.10
|
| Rate for Payer: ASR ASR |
$435.53
|
| Rate for Payer: ASR Commercial |
$435.53
|
| Rate for Payer: BCBS Trust/PPO |
$365.89
|
| Rate for Payer: BCN Commercial |
$348.11
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$422.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.20
|
| Rate for Payer: Healthscope Commercial |
$449.00
|
| Rate for Payer: Healthscope Whirlpool |
$435.53
|
| Rate for Payer: Mclaren Commercial |
$404.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.65
|
| Rate for Payer: Nomi Health Commercial |
$368.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.12
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 11443
|
| Min. Negotiated Rate |
$116.09 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Aetna Commercial |
$189.95
|
| Rate for Payer: Aetna Medicare |
$224.50
|
| Rate for Payer: BCBS Complete |
$121.89
|
| Rate for Payer: BCBS Trust/PPO |
$125.51
|
| Rate for Payer: BCN Commercial |
$268.97
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Meridian Medicaid |
$121.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.82
|
| Rate for Payer: Priority Health Narrow Network |
$243.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.69
|
| Rate for Payer: UHC Exchange |
$183.69
|
| Rate for Payer: UHCCP Medicaid |
$116.09
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
HCPCS 11444
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Aetna Medicare |
$288.50
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$333.37
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.58
|
| Rate for Payer: Priority Health Narrow Network |
$306.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.21
|
| Rate for Payer: UHC Exchange |
$236.21
|
| Rate for Payer: UHCCP Medicaid |
$146.76
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 11444
|
| Hospital Charge Code |
11444
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$375.05 |
| Max. Negotiated Rate |
$577.00 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: ASR ASR |
$559.69
|
| Rate for Payer: ASR Commercial |
$559.69
|
| Rate for Payer: BCBS Trust/PPO |
$470.20
|
| Rate for Payer: BCN Commercial |
$447.35
|
| Rate for Payer: Cash Price |
$461.60
|
| Rate for Payer: Cofinity Commercial |
$542.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.60
|
| Rate for Payer: Healthscope Commercial |
$577.00
|
| Rate for Payer: Healthscope Whirlpool |
$559.69
|
| Rate for Payer: Mclaren Commercial |
$519.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.45
|
| Rate for Payer: Nomi Health Commercial |
$473.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$507.76
|
|
