|
PR EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 11624
|
| Hospital Charge Code |
11624
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$1,307.96 |
| Rate for Payer: Aetna Commercial |
$254.89
|
| Rate for Payer: Aetna Medicare |
$297.50
|
| Rate for Payer: BCBS Complete |
$159.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,307.96
|
| Rate for Payer: BCN Commercial |
$494.05
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Meridian Medicaid |
$159.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.02
|
| Rate for Payer: Priority Health Narrow Network |
$321.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.78
|
| Rate for Payer: UHC Exchange |
$252.78
|
| Rate for Payer: UHCCP Medicaid |
$152.30
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 11624
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: ASR ASR |
$577.15
|
| Rate for Payer: ASR Commercial |
$577.15
|
| Rate for Payer: BCBS Trust/PPO |
$484.87
|
| Rate for Payer: BCN Commercial |
$461.30
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$559.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.00
|
| Rate for Payer: Healthscope Commercial |
$595.00
|
| Rate for Payer: Healthscope Whirlpool |
$577.15
|
| Rate for Payer: Mclaren Commercial |
$535.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.75
|
| Rate for Payer: Nomi Health Commercial |
$487.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.60
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 11624
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| 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 |
$577.15
|
| Rate for Payer: ASR Commercial |
$577.15
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$487.25
|
| Rate for Payer: BCN Commercial |
$461.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$559.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$595.00
|
| Rate for Payer: Healthscope Whirlpool |
$577.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$535.50
|
| 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 |
$505.75
|
| Rate for Payer: Nomi Health Commercial |
$487.90
|
| 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 |
$386.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$521.34
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$417.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$523.60
|
| 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 EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
11626
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$930.00 |
| Rate for Payer: Aetna Commercial |
$837.00
|
| Rate for Payer: ASR ASR |
$902.10
|
| Rate for Payer: ASR Commercial |
$902.10
|
| Rate for Payer: BCBS Trust/PPO |
$757.86
|
| Rate for Payer: BCN Commercial |
$721.03
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cofinity Commercial |
$874.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.00
|
| Rate for Payer: Healthscope Commercial |
$930.00
|
| Rate for Payer: Healthscope Whirlpool |
$902.10
|
| Rate for Payer: Mclaren Commercial |
$837.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.50
|
| Rate for Payer: Nomi Health Commercial |
$762.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$818.40
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 11626
|
| Min. Negotiated Rate |
$186.38 |
| Max. Negotiated Rate |
$2,976.66 |
| Rate for Payer: Aetna Commercial |
$315.59
|
| Rate for Payer: Aetna Medicare |
$465.00
|
| Rate for Payer: BCBS Complete |
$195.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,976.66
|
| Rate for Payer: BCN Commercial |
$478.66
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Meridian Medicaid |
$195.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$392.37
|
| Rate for Payer: Priority Health Narrow Network |
$392.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.57
|
| Rate for Payer: UHC Exchange |
$313.57
|
| Rate for Payer: UHCCP Medicaid |
$186.38
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 11626
|
| Hospital Charge Code |
11626
|
| Min. Negotiated Rate |
$186.38 |
| Max. Negotiated Rate |
$2,976.66 |
| Rate for Payer: Aetna Commercial |
$315.59
|
| Rate for Payer: Aetna Medicare |
$465.00
|
| Rate for Payer: BCBS Complete |
$195.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,976.66
|
| Rate for Payer: BCN Commercial |
$478.66
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Meridian Medicaid |
$195.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$392.37
|
| Rate for Payer: Priority Health Narrow Network |
$392.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.57
|
| Rate for Payer: UHC Exchange |
$313.57
|
| Rate for Payer: UHCCP Medicaid |
$186.38
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT 11626
|
| Hospital Charge Code |
11626
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$837.00
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$902.10
|
| Rate for Payer: ASR Commercial |
$902.10
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$761.58
|
| Rate for Payer: BCN Commercial |
$721.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cofinity Commercial |
$874.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$930.00
|
| Rate for Payer: Healthscope Whirlpool |
$902.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$837.00
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.50
|
| Rate for Payer: Nomi Health Commercial |
$762.60
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.87
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$651.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$818.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
11606
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$521.95 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Aetna Commercial |
$722.70
|
| Rate for Payer: ASR ASR |
$778.91
|
| Rate for Payer: ASR Commercial |
$778.91
|
| Rate for Payer: BCBS Trust/PPO |
$654.36
|
| Rate for Payer: BCN Commercial |
$622.57
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cofinity Commercial |
$754.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.40
|
| Rate for Payer: Healthscope Commercial |
$803.00
|
| Rate for Payer: Healthscope Whirlpool |
$778.91
|
| Rate for Payer: Mclaren Commercial |
$722.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.55
|
| Rate for Payer: Nomi Health Commercial |
$658.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$706.64
|
|
|
PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 11606
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$654.83 |
| Rate for Payer: Aetna Commercial |
$341.92
|
| Rate for Payer: Aetna Medicare |
$401.50
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS Trust/PPO |
$592.45
|
| Rate for Payer: BCN Commercial |
$654.83
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$427.14
|
| Rate for Payer: Priority Health Narrow Network |
$427.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.22
|
| Rate for Payer: UHC Exchange |
$333.22
|
| Rate for Payer: UHCCP Medicaid |
$202.35
|
|
|
PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 11606
|
| Hospital Charge Code |
11606
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$654.83 |
| Rate for Payer: Aetna Commercial |
$341.92
|
| Rate for Payer: Aetna Medicare |
$401.50
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS Trust/PPO |
$592.45
|
| Rate for Payer: BCN Commercial |
$654.83
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$427.14
|
| Rate for Payer: Priority Health Narrow Network |
$427.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.22
|
| Rate for Payer: UHC Exchange |
$333.22
|
| Rate for Payer: UHCCP Medicaid |
$202.35
|
|
|
PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 11606
|
| Hospital Charge Code |
11606
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$521.95 |
| Max. Negotiated Rate |
$2,460.59 |
| Rate for Payer: Aetna Commercial |
$722.70
|
| 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 |
$778.91
|
| Rate for Payer: ASR Commercial |
$778.91
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$657.58
|
| Rate for Payer: BCN Commercial |
$622.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cofinity Commercial |
$754.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$803.00
|
| Rate for Payer: Healthscope Whirlpool |
$778.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,587.48
|
| Rate for Payer: Mclaren Commercial |
$722.70
|
| 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 |
$682.55
|
| Rate for Payer: Nomi Health Commercial |
$658.46
|
| 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 |
$521.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.59
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$562.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$706.64
|
| 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 EXCISION MALIGNANT TUMOR MANDIBLE RADICAL
|
Professional
|
Both
|
$2,220.00
|
|
|
Service Code
|
HCPCS 21045
|
| Min. Negotiated Rate |
$99.81 |
| Max. Negotiated Rate |
$1,831.90 |
| Rate for Payer: Aetna Commercial |
$1,587.89
|
| Rate for Payer: Aetna Medicare |
$1,110.00
|
| Rate for Payer: BCBS Complete |
$808.50
|
| Rate for Payer: BCBS Trust/PPO |
$99.81
|
| Rate for Payer: BCN Commercial |
$1,753.86
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Meridian Medicaid |
$808.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,443.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,831.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,831.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,421.21
|
| Rate for Payer: UHC Exchange |
$1,421.21
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
PR EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 21034
|
| Min. Negotiated Rate |
$722.28 |
| Max. Negotiated Rate |
$1,900.96 |
| Rate for Payer: Aetna Commercial |
$1,501.25
|
| Rate for Payer: Aetna Medicare |
$1,377.00
|
| Rate for Payer: BCBS Complete |
$758.39
|
| Rate for Payer: BCN Commercial |
$1,900.96
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Meridian Medicaid |
$758.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$722.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,790.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,719.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,719.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,351.97
|
| Rate for Payer: UHC Exchange |
$1,351.97
|
| Rate for Payer: UHCCP Medicaid |
$722.28
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 11600
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$1,866.00 |
| Rate for Payer: Aetna Commercial |
$130.60
|
| Rate for Payer: Aetna Medicare |
$159.00
|
| Rate for Payer: BCBS Complete |
$82.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,866.00
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Meridian Medicaid |
$82.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.16
|
| Rate for Payer: Priority Health Narrow Network |
$166.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.29
|
| Rate for Payer: UHC Exchange |
$121.29
|
| Rate for Payer: UHCCP Medicaid |
$78.60
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 11601
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$269.37 |
| Rate for Payer: Aetna Commercial |
$158.43
|
| Rate for Payer: Aetna Medicare |
$188.50
|
| Rate for Payer: BCBS Complete |
$100.19
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$269.37
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Meridian Medicaid |
$100.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.93
|
| Rate for Payer: Priority Health Narrow Network |
$200.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.94
|
| Rate for Payer: UHC Exchange |
$154.94
|
| Rate for Payer: UHCCP Medicaid |
$95.42
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 11602
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$288.21 |
| Rate for Payer: Aetna Commercial |
$172.05
|
| Rate for Payer: Aetna Medicare |
$205.00
|
| Rate for Payer: BCBS Complete |
$108.92
|
| Rate for Payer: BCBS Trust/PPO |
$46.61
|
| Rate for Payer: BCN Commercial |
$288.21
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Meridian Medicaid |
$108.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.08
|
| Rate for Payer: Priority Health Narrow Network |
$218.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.56
|
| Rate for Payer: UHC Exchange |
$170.56
|
| Rate for Payer: UHCCP Medicaid |
$103.73
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
11602
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$397.70
|
| Rate for Payer: ASR Commercial |
$397.70
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$335.75
|
| Rate for Payer: BCN Commercial |
$317.87
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$385.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$410.00
|
| Rate for Payer: Healthscope Whirlpool |
$397.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$369.00
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.50
|
| Rate for Payer: Nomi Health Commercial |
$336.20
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.24
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$287.41
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 11602
|
| Hospital Charge Code |
11602
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$288.21 |
| Rate for Payer: Aetna Commercial |
$172.05
|
| Rate for Payer: Aetna Medicare |
$205.00
|
| Rate for Payer: BCBS Complete |
$108.92
|
| Rate for Payer: BCBS Trust/PPO |
$46.61
|
| Rate for Payer: BCN Commercial |
$288.21
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Meridian Medicaid |
$108.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.08
|
| Rate for Payer: Priority Health Narrow Network |
$218.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.56
|
| Rate for Payer: UHC Exchange |
$170.56
|
| Rate for Payer: UHCCP Medicaid |
$103.73
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 11602
|
| Hospital Charge Code |
11602
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Aetna Commercial |
$369.00
|
| Rate for Payer: ASR ASR |
$397.70
|
| Rate for Payer: ASR Commercial |
$397.70
|
| Rate for Payer: BCBS Trust/PPO |
$334.11
|
| Rate for Payer: BCN Commercial |
$317.87
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$385.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Healthscope Commercial |
$410.00
|
| Rate for Payer: Healthscope Whirlpool |
$397.70
|
| Rate for Payer: Mclaren Commercial |
$369.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.50
|
| Rate for Payer: Nomi Health Commercial |
$336.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.80
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
11603
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$303.55 |
| Max. Negotiated Rate |
$467.00 |
| Rate for Payer: Aetna Commercial |
$420.30
|
| Rate for Payer: ASR ASR |
$452.99
|
| Rate for Payer: ASR Commercial |
$452.99
|
| Rate for Payer: BCBS Trust/PPO |
$380.56
|
| Rate for Payer: BCN Commercial |
$362.07
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Cofinity Commercial |
$438.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.60
|
| Rate for Payer: Healthscope Commercial |
$467.00
|
| Rate for Payer: Healthscope Whirlpool |
$452.99
|
| Rate for Payer: Mclaren Commercial |
$420.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.95
|
| Rate for Payer: Nomi Health Commercial |
$382.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.96
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
11603
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$303.55 |
| Max. Negotiated Rate |
$1,068.51 |
| Rate for Payer: Aetna Commercial |
$420.30
|
| 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 |
$452.99
|
| Rate for Payer: ASR Commercial |
$452.99
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$382.43
|
| Rate for Payer: BCN Commercial |
$362.07
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Cofinity Commercial |
$438.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Healthscope Commercial |
$467.00
|
| Rate for Payer: Healthscope Whirlpool |
$452.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$689.36
|
| Rate for Payer: Mclaren Commercial |
$420.30
|
| 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 |
$396.95
|
| Rate for Payer: Nomi Health Commercial |
$382.94
|
| 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 |
$303.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.19
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$327.37
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.96
|
| 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 EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
HCPCS 11603
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$409.03 |
| Rate for Payer: Aetna Commercial |
$205.93
|
| Rate for Payer: Aetna Medicare |
$233.50
|
| Rate for Payer: BCBS Complete |
$130.17
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$409.03
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Meridian Medicaid |
$130.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.53
|
| Rate for Payer: Priority Health Narrow Network |
$260.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.92
|
| Rate for Payer: UHC Exchange |
$202.92
|
| Rate for Payer: UHCCP Medicaid |
$123.97
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
HCPCS 11603
|
| Hospital Charge Code |
11603
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$409.03 |
| Rate for Payer: Aetna Commercial |
$205.93
|
| Rate for Payer: Aetna Medicare |
$233.50
|
| Rate for Payer: BCBS Complete |
$130.17
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$409.03
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Cash Price |
$373.60
|
| Rate for Payer: Meridian Medicaid |
$130.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$260.53
|
| Rate for Payer: Priority Health Narrow Network |
$260.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.92
|
| Rate for Payer: UHC Exchange |
$202.92
|
| Rate for Payer: UHCCP Medicaid |
$123.97
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 11604
|
| Min. Negotiated Rate |
$136.53 |
| Max. Negotiated Rate |
$5,686.65 |
| Rate for Payer: Aetna Commercial |
$228.37
|
| Rate for Payer: Aetna Medicare |
$260.50
|
| Rate for Payer: BCBS Complete |
$143.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,686.65
|
| Rate for Payer: BCN Commercial |
$455.45
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Meridian Medicaid |
$143.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.72
|
| Rate for Payer: Priority Health Narrow Network |
$286.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.70
|
| Rate for Payer: UHC Exchange |
$223.70
|
| Rate for Payer: UHCCP Medicaid |
$136.53
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 11604
|
| Hospital Charge Code |
11604
|
| Min. Negotiated Rate |
$136.53 |
| Max. Negotiated Rate |
$5,686.65 |
| Rate for Payer: Aetna Commercial |
$228.37
|
| Rate for Payer: Aetna Medicare |
$260.50
|
| Rate for Payer: BCBS Complete |
$143.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,686.65
|
| Rate for Payer: BCN Commercial |
$455.45
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Meridian Medicaid |
$143.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$286.72
|
| Rate for Payer: Priority Health Narrow Network |
$286.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.70
|
| Rate for Payer: UHC Exchange |
$223.70
|
| Rate for Payer: UHCCP Medicaid |
$136.53
|
|
