|
PR SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
HCPCS 45337
|
| Min. Negotiated Rate |
$72.21 |
| Max. Negotiated Rate |
$393.90 |
| Rate for Payer: Aetna Commercial |
$153.40
|
| Rate for Payer: Aetna Medicare |
$303.00
|
| Rate for Payer: BCBS Complete |
$75.82
|
| Rate for Payer: BCBS Trust/PPO |
$349.73
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Meridian Medicaid |
$75.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.65
|
| Rate for Payer: Priority Health Narrow Network |
$201.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.29
|
| Rate for Payer: UHC Exchange |
$177.29
|
| Rate for Payer: UHCCP Medicaid |
$72.21
|
|
|
PR SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 45349
|
| Min. Negotiated Rate |
$124.82 |
| Max. Negotiated Rate |
$380.90 |
| Rate for Payer: Aetna Commercial |
$263.62
|
| Rate for Payer: Aetna Medicare |
$182.50
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS Trust/PPO |
$380.90
|
| Rate for Payer: BCN Commercial |
$284.41
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.41
|
| Rate for Payer: Priority Health Narrow Network |
$348.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.00
|
| Rate for Payer: UHC Exchange |
$274.00
|
| Rate for Payer: UHCCP Medicaid |
$124.82
|
|
|
PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 11310
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$137.83 |
| Rate for Payer: Aetna Commercial |
$49.47
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: BCBS Complete |
$30.20
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$137.83
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Meridian Medicaid |
$30.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.96
|
| Rate for Payer: Priority Health Narrow Network |
$60.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.34
|
| Rate for Payer: UHC Exchange |
$46.34
|
| Rate for Payer: UHCCP Medicaid |
$28.76
|
|
|
PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 11313
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$214.00
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.68
|
| Rate for Payer: Priority Health Narrow Network |
$128.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.22
|
| Rate for Payer: UHC Exchange |
$105.22
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
|
|
PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 11305
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: BCBS Complete |
$24.82
|
| Rate for Payer: BCBS Trust/PPO |
$450.00
|
| Rate for Payer: BCN Commercial |
$124.87
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Meridian Medicaid |
$24.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.12
|
| Rate for Payer: Priority Health Narrow Network |
$50.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.91
|
| Rate for Payer: UHC Exchange |
$37.91
|
| Rate for Payer: UHCCP Medicaid |
$23.64
|
|
|
PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 11306
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$145.29 |
| Rate for Payer: Aetna Commercial |
$53.87
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$145.29
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.47
|
| Rate for Payer: Priority Health Narrow Network |
$65.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.66
|
| Rate for Payer: UHC Exchange |
$59.66
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
|
|
PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 11307
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$2,827.44 |
| Rate for Payer: Aetna Commercial |
$69.07
|
| Rate for Payer: Aetna Medicare |
$118.50
|
| Rate for Payer: BCBS Complete |
$41.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,827.44
|
| Rate for Payer: BCN Commercial |
$164.53
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Meridian Medicaid |
$41.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.53
|
| Rate for Payer: Priority Health Narrow Network |
$83.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.31
|
| Rate for Payer: UHC Exchange |
$71.31
|
| Rate for Payer: UHCCP Medicaid |
$39.19
|
|
|
PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 11308
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$78.76
|
| Rate for Payer: Aetna Medicare |
$125.50
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$173.16
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.47
|
| Rate for Payer: Priority Health Narrow Network |
$93.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.04
|
| Rate for Payer: UHC Exchange |
$83.04
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
|
|
PR SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 11300
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: BCBS Complete |
$22.59
|
| Rate for Payer: BCBS Trust/PPO |
$285.00
|
| Rate for Payer: BCN Commercial |
$119.76
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Meridian Medicaid |
$22.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.60
|
| Rate for Payer: Priority Health Narrow Network |
$45.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.25
|
| Rate for Payer: UHC Exchange |
$32.25
|
| Rate for Payer: UHCCP Medicaid |
$21.51
|
|
|
PR SHOE LIFTS ELEVATION HEEL /I
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS L3334
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$42.25 |
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCN Commercial |
$36.21
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC Exchange |
$20.72
|
|
|
PR SHORTENING TENDON EXTENSOR HAND/FINGER EACH
|
Professional
|
Both
|
$1,208.00
|
|
|
Service Code
|
HCPCS 26477
|
| Min. Negotiated Rate |
$405.77 |
| Max. Negotiated Rate |
$975.48 |
| Rate for Payer: Aetna Commercial |
$822.68
|
| Rate for Payer: Aetna Medicare |
$604.00
|
| Rate for Payer: BCBS Complete |
$426.06
|
| Rate for Payer: BCBS Trust/PPO |
$974.19
|
| Rate for Payer: BCN Commercial |
$932.88
|
| Rate for Payer: Cash Price |
$966.40
|
| Rate for Payer: Cash Price |
$966.40
|
| Rate for Payer: Meridian Medicaid |
$426.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$975.48
|
| Rate for Payer: Priority Health Narrow Network |
$975.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$636.98
|
| Rate for Payer: UHC Exchange |
$636.98
|
| Rate for Payer: UHCCP Medicaid |
$405.77
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 95926
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$873.81 |
| Rate for Payer: Aetna Commercial |
$153.65
|
| Rate for Payer: Aetna Medicare |
$158.50
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$873.81
|
| Rate for Payer: BCN Commercial |
$226.75
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Meridian Medicaid |
$17.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.19
|
| Rate for Payer: Priority Health Narrow Network |
$36.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$130.55
|
| Rate for Payer: UHC Exchange |
$130.55
|
| Rate for Payer: UHCCP Medicaid |
$16.61
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 95927
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$242.39 |
| Rate for Payer: Aetna Commercial |
$150.85
|
| Rate for Payer: Aetna Commercial |
$150.85
|
| Rate for Payer: Aetna Medicare |
$144.00
|
| Rate for Payer: Aetna Medicare |
$100.50
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Trust/PPO |
$99.85
|
| Rate for Payer: BCBS Trust/PPO |
$99.85
|
| Rate for Payer: BCN Commercial |
$242.39
|
| Rate for Payer: BCN Commercial |
$242.39
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.19
|
| Rate for Payer: Priority Health Narrow Network |
$36.19
|
| Rate for Payer: Priority Health Narrow Network |
$36.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.16
|
| Rate for Payer: UHC Exchange |
$127.16
|
| Rate for Payer: UHC Exchange |
$127.16
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 95925
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$1,239.39 |
| Rate for Payer: Aetna Commercial |
$166.52
|
| Rate for Payer: Aetna Medicare |
$163.50
|
| Rate for Payer: BCBS Complete |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.39
|
| Rate for Payer: BCN Commercial |
$259.98
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Meridian Medicaid |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.10
|
| Rate for Payer: Priority Health Narrow Network |
$37.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.11
|
| Rate for Payer: UHC Exchange |
$133.11
|
| Rate for Payer: UHCCP Medicaid |
$17.25
|
|
|
PR SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 95938
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$556.30 |
| Rate for Payer: Aetna Commercial |
$379.87
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$556.30
|
| Rate for Payer: BCN Commercial |
$531.68
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$29.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.15
|
| Rate for Payer: Priority Health Narrow Network |
$60.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.26
|
| Rate for Payer: UHC Exchange |
$325.26
|
| Rate for Payer: UHCCP Medicaid |
$28.33
|
|
|
PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 11311
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$338.18 |
| Rate for Payer: Aetna Commercial |
$68.44
|
| Rate for Payer: Aetna Medicare |
$92.50
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$338.18
|
| Rate for Payer: BCN Commercial |
$161.77
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Meridian Medicaid |
$42.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.98
|
| Rate for Payer: Priority Health Narrow Network |
$83.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.05
|
| Rate for Payer: UHC Exchange |
$68.05
|
| Rate for Payer: UHCCP Medicaid |
$40.04
|
|
|
PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 11312
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$184.94 |
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna Medicare |
$133.00
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$184.94
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.33
|
| Rate for Payer: Priority Health Narrow Network |
$99.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.97
|
| Rate for Payer: UHC Exchange |
$78.97
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
11301
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$192.06
|
| Rate for Payer: ASR Commercial |
$192.06
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$162.14
|
| Rate for Payer: BCN Commercial |
$153.51
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$186.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Healthscope Whirlpool |
$192.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$178.20
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.30
|
| Rate for Payer: Nomi Health Commercial |
$162.36
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.49
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$138.80
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 11301
|
| Hospital Charge Code |
11301
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$507.28 |
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS Trust/PPO |
$507.28
|
| Rate for Payer: BCN Commercial |
$144.11
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.63
|
| Rate for Payer: Priority Health Narrow Network |
$68.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.77
|
| Rate for Payer: UHC Exchange |
$54.77
|
| Rate for Payer: UHCCP Medicaid |
$32.80
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 11301
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$507.28 |
| Rate for Payer: Aetna Commercial |
$55.41
|
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS Trust/PPO |
$507.28
|
| Rate for Payer: BCN Commercial |
$144.11
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.63
|
| Rate for Payer: Priority Health Narrow Network |
$68.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.77
|
| Rate for Payer: UHC Exchange |
$54.77
|
| Rate for Payer: UHCCP Medicaid |
$32.80
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
11301
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: ASR ASR |
$192.06
|
| Rate for Payer: ASR Commercial |
$192.06
|
| Rate for Payer: BCBS Trust/PPO |
$161.35
|
| Rate for Payer: BCN Commercial |
$153.51
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$186.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Healthscope Whirlpool |
$192.06
|
| Rate for Payer: Mclaren Commercial |
$178.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.30
|
| Rate for Payer: Nomi Health Commercial |
$162.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.24
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 11303
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$2,827.44 |
| Rate for Payer: Aetna Commercial |
$76.99
|
| Rate for Payer: Aetna Medicare |
$128.50
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,827.44
|
| Rate for Payer: BCN Commercial |
$179.84
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.27
|
| Rate for Payer: Priority Health Narrow Network |
$95.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.81
|
| Rate for Payer: UHC Exchange |
$79.81
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 11302
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$162.17 |
| Rate for Payer: Aetna Commercial |
$65.07
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$162.17
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.92
|
| Rate for Payer: Priority Health Narrow Network |
$79.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.66
|
| Rate for Payer: UHC Exchange |
$67.66
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
PR SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL
|
Professional
|
Both
|
$782.00
|
|
|
Service Code
|
HCPCS 42340
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$788.73 |
| Rate for Payer: Aetna Commercial |
$447.54
|
| Rate for Payer: Aetna Medicare |
$391.00
|
| Rate for Payer: BCBS Complete |
$234.61
|
| Rate for Payer: BCBS Trust/PPO |
$782.41
|
| Rate for Payer: BCN Commercial |
$788.73
|
| Rate for Payer: Cash Price |
$625.60
|
| Rate for Payer: Cash Price |
$625.60
|
| Rate for Payer: Meridian Medicaid |
$234.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$624.63
|
| Rate for Payer: Priority Health Narrow Network |
$624.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$410.28
|
| Rate for Payer: UHC Exchange |
$410.28
|
| Rate for Payer: UHCCP Medicaid |
$223.44
|
|
|
PR SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL
|
Professional
|
Both
|
$1,021.00
|
|
|
Service Code
|
HCPCS 42335
|
| Min. Negotiated Rate |
$171.47 |
| Max. Negotiated Rate |
$663.65 |
| Rate for Payer: Aetna Commercial |
$339.73
|
| Rate for Payer: Aetna Medicare |
$510.50
|
| Rate for Payer: BCBS Complete |
$180.04
|
| Rate for Payer: BCBS Trust/PPO |
$395.70
|
| Rate for Payer: BCN Commercial |
$639.67
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Meridian Medicaid |
$180.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.68
|
| Rate for Payer: Priority Health Narrow Network |
$476.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.99
|
| Rate for Payer: UHC Exchange |
$310.99
|
| Rate for Payer: UHCCP Medicaid |
$171.47
|
|
