|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
11401
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: ASR ASR |
$239.59
|
| Rate for Payer: ASR Commercial |
$239.59
|
| Rate for Payer: BCBS Trust/PPO |
$201.28
|
| Rate for Payer: BCN Commercial |
$191.50
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$232.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.60
|
| Rate for Payer: Healthscope Commercial |
$247.00
|
| Rate for Payer: Healthscope Whirlpool |
$239.59
|
| Rate for Payer: Mclaren Commercial |
$222.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.95
|
| Rate for Payer: Nomi Health Commercial |
$202.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.36
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 11401
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Aetna Medicare |
$99.63
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$99.63
|
| Rate for Payer: BCN Medicare Advantage |
$99.63
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$133.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.63
|
| Rate for Payer: Healthscope Commercial |
$119.56
|
| Rate for Payer: Healthscope Whirlpool |
$119.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.61
|
| Rate for Payer: Nomi Health Commercial |
$119.56
|
| Rate for Payer: PACE SWMI |
$99.63
|
| Rate for Payer: PHP Medicare Advantage |
$99.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.63
|
| Rate for Payer: UHC Medicare Advantage |
$99.63
|
| Rate for Payer: UHCCP DNSP |
$99.63
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 11401
|
| Hospital Charge Code |
11401
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$133.50
|
| Rate for Payer: Aetna Medicare |
$99.63
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$99.63
|
| Rate for Payer: BCN Medicare Advantage |
$99.63
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$133.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.63
|
| Rate for Payer: Healthscope Commercial |
$119.56
|
| Rate for Payer: Healthscope Whirlpool |
$119.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.61
|
| Rate for Payer: Nomi Health Commercial |
$119.56
|
| Rate for Payer: PACE SWMI |
$99.63
|
| Rate for Payer: PHP Medicare Advantage |
$99.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.63
|
| Rate for Payer: UHC Medicare Advantage |
$99.63
|
| Rate for Payer: UHCCP DNSP |
$99.63
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$274.00 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: ASR ASR |
$265.78
|
| Rate for Payer: ASR Commercial |
$265.78
|
| Rate for Payer: BCBS Trust/PPO |
$223.28
|
| Rate for Payer: BCN Commercial |
$212.43
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$257.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Healthscope Whirlpool |
$265.78
|
| Rate for Payer: Mclaren Commercial |
$246.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Nomi Health Commercial |
$224.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.12
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
11402
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$178.10 |
| Max. Negotiated Rate |
$1,063.61 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$265.78
|
| Rate for Payer: ASR Commercial |
$265.78
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$224.38
|
| Rate for Payer: BCN Commercial |
$212.43
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$257.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$274.00
|
| Rate for Payer: Healthscope Whirlpool |
$265.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$246.60
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.90
|
| Rate for Payer: Nomi Health Commercial |
$224.68
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.08
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$192.07
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$109.13 |
| Max. Negotiated Rate |
$178.10 |
| Rate for Payer: Aetna Commercial |
$146.23
|
| Rate for Payer: Aetna Medicare |
$109.13
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS MAPPO |
$109.13
|
| Rate for Payer: BCN Medicare Advantage |
$109.13
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Commercial |
$146.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.13
|
| Rate for Payer: Healthscope Commercial |
$130.96
|
| Rate for Payer: Healthscope Whirlpool |
$130.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.59
|
| Rate for Payer: Nomi Health Commercial |
$130.96
|
| Rate for Payer: PACE SWMI |
$109.13
|
| Rate for Payer: PHP Medicare Advantage |
$109.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Medicare |
$109.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.13
|
| Rate for Payer: UHC Medicare Advantage |
$109.13
|
| Rate for Payer: UHCCP DNSP |
$109.13
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 11402
|
| Hospital Charge Code |
11402
|
| Min. Negotiated Rate |
$109.13 |
| Max. Negotiated Rate |
$178.10 |
| Rate for Payer: Aetna Commercial |
$146.23
|
| Rate for Payer: Aetna Medicare |
$109.13
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS MAPPO |
$109.13
|
| Rate for Payer: BCN Medicare Advantage |
$109.13
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Commercial |
$146.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.13
|
| Rate for Payer: Healthscope Commercial |
$130.96
|
| Rate for Payer: Healthscope Whirlpool |
$130.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.59
|
| Rate for Payer: Nomi Health Commercial |
$130.96
|
| Rate for Payer: PACE SWMI |
$109.13
|
| Rate for Payer: PHP Medicare Advantage |
$109.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Medicare |
$109.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.13
|
| Rate for Payer: UHC Medicare Advantage |
$109.13
|
| Rate for Payer: UHCCP DNSP |
$109.13
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
11403
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Trust/PPO |
$267.29
|
| Rate for Payer: BCN Commercial |
$254.30
|
| 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: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
|
|
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 |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$142.34
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCN Medicare Advantage |
$142.34
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$204.97
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.34
|
| Rate for Payer: Healthscope Commercial |
$170.81
|
| Rate for Payer: Healthscope Whirlpool |
$170.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.46
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: PACE SWMI |
$142.34
|
| Rate for Payer: PHP Medicare Advantage |
$142.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$142.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
| Rate for Payer: UHCCP DNSP |
$142.34
|
|
|
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 |
$1,063.61 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$318.16
|
| Rate for Payer: ASR Commercial |
$318.16
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$268.60
|
| Rate for Payer: BCN Commercial |
$254.30
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| 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 |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$328.00
|
| Rate for Payer: Healthscope Whirlpool |
$318.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$295.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.39
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$229.93
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$288.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
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 |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$142.34
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCN Medicare Advantage |
$142.34
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$204.97
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.34
|
| Rate for Payer: Healthscope Commercial |
$170.81
|
| Rate for Payer: Healthscope Whirlpool |
$170.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.46
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: PACE SWMI |
$142.34
|
| Rate for Payer: PHP Medicare Advantage |
$142.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$142.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
| Rate for Payer: UHCCP DNSP |
$142.34
|
|
|
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 |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$418.50
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$451.05
|
| Rate for Payer: ASR Commercial |
$451.05
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$380.79
|
| Rate for Payer: BCN Commercial |
$360.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| 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 |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$465.00
|
| Rate for Payer: Healthscope Whirlpool |
$451.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$418.50
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.25
|
| Rate for Payer: Nomi Health Commercial |
$381.30
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$407.43
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$325.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$409.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
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 |
$157.35 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$210.85
|
| Rate for Payer: Aetna Medicare |
$157.35
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: BCBS MAPPO |
$157.35
|
| Rate for Payer: BCN Medicare Advantage |
$157.35
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$226.58
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.35
|
| Rate for Payer: Healthscope Commercial |
$188.82
|
| Rate for Payer: Healthscope Whirlpool |
$188.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.22
|
| Rate for Payer: Nomi Health Commercial |
$188.82
|
| Rate for Payer: PACE SWMI |
$157.35
|
| Rate for Payer: PHP Medicare Advantage |
$157.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health Medicare |
$157.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.35
|
| Rate for Payer: UHC Medicare Advantage |
$157.35
|
| Rate for Payer: UHCCP DNSP |
$157.35
|
|
|
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 |
$157.35 |
| Max. Negotiated Rate |
$302.25 |
| Rate for Payer: Aetna Commercial |
$210.85
|
| Rate for Payer: Aetna Medicare |
$157.35
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: BCBS MAPPO |
$157.35
|
| Rate for Payer: BCN Medicare Advantage |
$157.35
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$226.58
|
| Rate for Payer: Cofinity Commercial |
$210.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.35
|
| Rate for Payer: Healthscope Commercial |
$188.82
|
| Rate for Payer: Healthscope Whirlpool |
$188.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.22
|
| Rate for Payer: Nomi Health Commercial |
$188.82
|
| Rate for Payer: PACE SWMI |
$157.35
|
| Rate for Payer: PHP Medicare Advantage |
$157.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health Medicare |
$157.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.35
|
| Rate for Payer: UHC Medicare Advantage |
$157.35
|
| Rate for Payer: UHCCP DNSP |
$157.35
|
|
|
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 |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$637.29
|
| Rate for Payer: ASR Commercial |
$637.29
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$538.02
|
| Rate for Payer: BCN Commercial |
$509.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| 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 |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$657.00
|
| Rate for Payer: Healthscope Whirlpool |
$637.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$591.30
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$558.45
|
| Rate for Payer: Nomi Health Commercial |
$538.74
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$575.66
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$460.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
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 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 |
$238.04 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$318.97
|
| Rate for Payer: Aetna Medicare |
$238.04
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$238.04
|
| Rate for Payer: BCN Medicare Advantage |
$238.04
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$342.78
|
| Rate for Payer: Cofinity Commercial |
$318.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.04
|
| Rate for Payer: Healthscope Commercial |
$285.65
|
| Rate for Payer: Healthscope Whirlpool |
$285.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.94
|
| Rate for Payer: Nomi Health Commercial |
$285.65
|
| Rate for Payer: PACE SWMI |
$238.04
|
| Rate for Payer: PHP Medicare Advantage |
$238.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$238.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.04
|
| Rate for Payer: UHC Medicare Advantage |
$238.04
|
| Rate for Payer: UHCCP DNSP |
$238.04
|
|
|
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 |
$238.04 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$318.97
|
| Rate for Payer: Aetna Medicare |
$238.04
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$238.04
|
| Rate for Payer: BCN Medicare Advantage |
$238.04
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$342.78
|
| Rate for Payer: Cofinity Commercial |
$318.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.04
|
| Rate for Payer: Healthscope Commercial |
$285.65
|
| Rate for Payer: Healthscope Whirlpool |
$285.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.94
|
| Rate for Payer: Nomi Health Commercial |
$285.65
|
| Rate for Payer: PACE SWMI |
$238.04
|
| Rate for Payer: PHP Medicare Advantage |
$238.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$238.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.04
|
| Rate for Payer: UHC Medicare Advantage |
$238.04
|
| Rate for Payer: UHCCP DNSP |
$238.04
|
|
|
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 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 |
$1,063.61 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$269.66
|
| Rate for Payer: ASR Commercial |
$269.66
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$227.65
|
| Rate for Payer: BCN Commercial |
$215.53
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| 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 |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$278.00
|
| Rate for Payer: Healthscope Whirlpool |
$269.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$250.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$227.96
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.58
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$194.88
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
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 |
$111.20 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$167.47
|
| Rate for Payer: Aetna Medicare |
$124.98
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$124.98
|
| Rate for Payer: BCN Medicare Advantage |
$124.98
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$179.97
|
| Rate for Payer: Cofinity Commercial |
$167.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.98
|
| Rate for Payer: Healthscope Commercial |
$149.98
|
| Rate for Payer: Healthscope Whirlpool |
$149.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.23
|
| Rate for Payer: Nomi Health Commercial |
$149.98
|
| Rate for Payer: PACE SWMI |
$124.98
|
| Rate for Payer: PHP Medicare Advantage |
$124.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$124.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.98
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: UHCCP DNSP |
$124.98
|
|
|
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 |
$111.20 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$167.47
|
| Rate for Payer: Aetna Medicare |
$124.98
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$124.98
|
| Rate for Payer: BCN Medicare Advantage |
$124.98
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$179.97
|
| Rate for Payer: Cofinity Commercial |
$167.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.98
|
| Rate for Payer: Healthscope Commercial |
$149.98
|
| Rate for Payer: Healthscope Whirlpool |
$149.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.23
|
| Rate for Payer: Nomi Health Commercial |
$149.98
|
| Rate for Payer: PACE SWMI |
$124.98
|
| Rate for Payer: PHP Medicare Advantage |
$124.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$124.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.98
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: UHCCP DNSP |
$124.98
|
|
|
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
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 11442
|
| Min. Negotiated Rate |
$138.77 |
| Max. Negotiated Rate |
$229.45 |
| Rate for Payer: Aetna Commercial |
$185.95
|
| Rate for Payer: Aetna Medicare |
$138.77
|
| Rate for Payer: BCBS Complete |
$141.20
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCN Medicare Advantage |
$138.77
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$199.83
|
| Rate for Payer: Cofinity Commercial |
$185.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.77
|
| Rate for Payer: Healthscope Commercial |
$166.52
|
| Rate for Payer: Healthscope Whirlpool |
$166.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.71
|
| Rate for Payer: Nomi Health Commercial |
$166.52
|
| Rate for Payer: PACE SWMI |
$138.77
|
| Rate for Payer: PHP Medicare Advantage |
$138.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.77
|
| Rate for Payer: UHC Medicare Advantage |
$138.77
|
| Rate for Payer: UHCCP DNSP |
$138.77
|
|
