|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA 2.1 TO 3.0 CM
|
Facility
|
IP
|
$315.95
|
|
|
Service Code
|
CPT 17273
|
| Hospital Charge Code |
76100130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.05 |
| Max. Negotiated Rate |
$284.36 |
| Rate for Payer: Aetna Commercial |
$268.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.37
|
| Rate for Payer: Cash Price |
$252.76
|
| Rate for Payer: Cofinity Advantage |
$221.16
|
| Rate for Payer: Cofinity Commercial |
$271.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.76
|
| Rate for Payer: Healthscope Commercial |
$284.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.96
|
| Rate for Payer: PHP Commercial |
$268.56
|
| Rate for Payer: Priority Health SBD |
$199.05
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA 2.1 TO 3.0 CM
|
Facility
|
OP
|
$315.95
|
|
|
Service Code
|
CPT 17273
|
| Hospital Charge Code |
76100130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.17 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$268.56
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$122.17
|
| Rate for Payer: BCN Commercial |
$122.17
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$252.76
|
| Rate for Payer: Cash Price |
$252.76
|
| Rate for Payer: Cash Price |
$252.76
|
| Rate for Payer: Cofinity Advantage |
$221.16
|
| Rate for Payer: Cofinity Commercial |
$271.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$284.36
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.96
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$268.56
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$199.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.37
|
| Rate for Payer: UHC Core |
$164.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$124.17
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.5 CM OR LESS
|
Facility
|
OP
|
$165.06
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
76100125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$105.13
|
| Rate for Payer: BCN Commercial |
$105.13
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Advantage |
$115.54
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$103.99
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.29
|
| Rate for Payer: UHC Core |
$86.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$64.87
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.5 CM OR LESS
|
Facility
|
IP
|
$165.06
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
76100125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.29
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Advantage |
$115.54
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: Priority Health SBD |
$103.99
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.6 TO 1.0 CM
|
Facility
|
IP
|
$165.06
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.29
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Advantage |
$115.54
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: Priority Health SBD |
$103.99
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.6 TO 1.0 CM
|
Facility
|
OP
|
$165.06
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$115.05
|
| Rate for Payer: BCN Commercial |
$115.05
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Advantage |
$115.54
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$103.99
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.29
|
| Rate for Payer: UHC Core |
$86.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$64.87
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM
|
Facility
|
IP
|
$165.06
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.29
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Advantage |
$115.54
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: Priority Health SBD |
$103.99
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM
|
Facility
|
OP
|
$165.06
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$114.28
|
| Rate for Payer: BCN Commercial |
$114.28
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cash Price |
$132.05
|
| Rate for Payer: Cofinity Advantage |
$115.54
|
| Rate for Payer: Cofinity Commercial |
$141.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$148.55
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.30
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.80
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$140.30
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$103.99
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.29
|
| Rate for Payer: UHC Core |
$86.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$64.87
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
OP
|
$543.09
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$461.63
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$105.13
|
| Rate for Payer: BCN Commercial |
$105.13
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$434.47
|
| Rate for Payer: Cash Price |
$434.47
|
| Rate for Payer: Cash Price |
$434.47
|
| Rate for Payer: Cofinity Advantage |
$380.16
|
| Rate for Payer: Cofinity Commercial |
$467.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$488.78
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.63
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$407.32
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$461.63
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$342.15
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.01
|
| Rate for Payer: UHC Core |
$282.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$213.43
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
IP
|
$543.09
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.15 |
| Max. Negotiated Rate |
$488.78 |
| Rate for Payer: Aetna Commercial |
$461.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.01
|
| Rate for Payer: Cash Price |
$434.47
|
| Rate for Payer: Cofinity Advantage |
$380.16
|
| Rate for Payer: Cofinity Commercial |
$467.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.47
|
| Rate for Payer: Healthscope Commercial |
$488.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$407.32
|
| Rate for Payer: PHP Commercial |
$461.63
|
| Rate for Payer: Priority Health SBD |
$342.15
|
|
|
HC DESTRUCT MOUTH LESION
|
Facility
|
OP
|
$9,995.00
|
|
|
Service Code
|
CPT 40820
|
| Hospital Charge Code |
76100538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.35 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Commercial |
$8,495.75
|
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,496.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$214.35
|
| Rate for Payer: BCN Commercial |
$214.35
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Cash Price |
$7,996.00
|
| Rate for Payer: Cash Price |
$7,996.00
|
| Rate for Payer: Cash Price |
$7,996.00
|
| Rate for Payer: Cofinity Advantage |
$6,996.50
|
| Rate for Payer: Cofinity Commercial |
$8,595.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,996.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Healthscope Commercial |
$8,995.50
|
| Rate for Payer: Mclaren Medicaid |
$1,727.75
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,495.75
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,496.25
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Commercial |
$8,495.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health SBD |
$6,296.85
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,496.75
|
| Rate for Payer: UHC Core |
$5,207.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Exchange |
$3,928.03
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
HC DESTRUCT MOUTH LESION
|
Facility
|
IP
|
$9,995.00
|
|
|
Service Code
|
CPT 40820
|
| Hospital Charge Code |
76100538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,296.85 |
| Max. Negotiated Rate |
$8,995.50 |
| Rate for Payer: Aetna Commercial |
$8,495.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,496.75
|
| Rate for Payer: Cash Price |
$7,996.00
|
| Rate for Payer: Cofinity Advantage |
$6,996.50
|
| Rate for Payer: Cofinity Commercial |
$8,595.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,996.00
|
| Rate for Payer: Healthscope Commercial |
$8,995.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,495.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,496.25
|
| Rate for Payer: PHP Commercial |
$8,495.75
|
| Rate for Payer: Priority Health SBD |
$6,296.85
|
|
|
HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV
|
Facility
|
OP
|
$417.06
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
36100608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Commercial |
$354.50
|
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$39.09
|
| Rate for Payer: BCN Commercial |
$39.09
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$333.65
|
| Rate for Payer: Cash Price |
$333.65
|
| Rate for Payer: Cash Price |
$333.65
|
| Rate for Payer: Cofinity Advantage |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Mclaren Medicaid |
$159.96
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.50
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.80
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$354.50
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health SBD |
$262.75
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV
|
Facility
|
IP
|
$417.06
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
36100608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.75 |
| Max. Negotiated Rate |
$375.35 |
| Rate for Payer: Aetna Commercial |
$354.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.09
|
| Rate for Payer: Cash Price |
$333.65
|
| Rate for Payer: Cofinity Advantage |
$291.94
|
| Rate for Payer: Cofinity Commercial |
$358.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.65
|
| Rate for Payer: Healthscope Commercial |
$375.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.80
|
| Rate for Payer: PHP Commercial |
$354.50
|
| Rate for Payer: Priority Health SBD |
$262.75
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
IP
|
$287.22
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.95 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$244.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.69
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Advantage |
$201.05
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Healthscope Commercial |
$258.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: PHP Commercial |
$244.14
|
| Rate for Payer: Priority Health SBD |
$180.95
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
OP
|
$287.22
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.88 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$244.14
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$120.15
|
| Rate for Payer: BCN Commercial |
$120.15
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Advantage |
$201.05
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$258.50
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.14
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$244.14
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$180.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.69
|
| Rate for Payer: UHC Core |
$149.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Exchange |
$112.88
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
IP
|
$180.06
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.44 |
| Max. Negotiated Rate |
$162.05 |
| Rate for Payer: Aetna Commercial |
$153.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.04
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cofinity Advantage |
$126.04
|
| Rate for Payer: Cofinity Commercial |
$154.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.05
|
| Rate for Payer: Healthscope Commercial |
$162.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.04
|
| Rate for Payer: PHP Commercial |
$153.05
|
| Rate for Payer: Priority Health SBD |
$113.44
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
OP
|
$180.06
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$153.05
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$93.99
|
| Rate for Payer: BCN Commercial |
$93.99
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cash Price |
$144.05
|
| Rate for Payer: Cofinity Advantage |
$126.04
|
| Rate for Payer: Cofinity Commercial |
$154.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$162.05
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.05
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.04
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$153.05
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$113.44
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.04
|
| Rate for Payer: UHC Core |
$93.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$70.76
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
IP
|
$36.19
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$32.57 |
| Rate for Payer: Aetna Commercial |
$30.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.52
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cofinity Advantage |
$25.33
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.95
|
| Rate for Payer: Healthscope Commercial |
$32.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.14
|
| Rate for Payer: PHP Commercial |
$30.76
|
| Rate for Payer: Priority Health SBD |
$22.80
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
OP
|
$36.19
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$32.57 |
| Rate for Payer: Aetna Commercial |
$30.76
|
| Rate for Payer: Aetna Medicare |
$18.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.52
|
| Rate for Payer: BCBS Complete |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$14.87
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cash Price |
$28.95
|
| Rate for Payer: Cofinity Advantage |
$25.33
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.95
|
| Rate for Payer: Healthscope Commercial |
$32.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.14
|
| Rate for Payer: PHP Commercial |
$30.76
|
| Rate for Payer: Priority Health SBD |
$22.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.52
|
| Rate for Payer: UHC Core |
$18.85
|
| Rate for Payer: UHC Exchange |
$14.22
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
OP
|
$3,976.50
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Commercial |
$3,380.03
|
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,584.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$61.10
|
| Rate for Payer: BCN Commercial |
$61.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Cash Price |
$3,181.20
|
| Rate for Payer: Cash Price |
$3,181.20
|
| Rate for Payer: Cash Price |
$3,181.20
|
| Rate for Payer: Cofinity Advantage |
$2,783.55
|
| Rate for Payer: Cofinity Commercial |
$3,419.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,181.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Healthscope Commercial |
$3,578.85
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,380.03
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,982.38
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Commercial |
$3,380.03
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health SBD |
$2,505.20
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,584.72
|
| Rate for Payer: UHC Core |
$2,071.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Exchange |
$1,562.76
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
IP
|
$3,976.50
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,505.20 |
| Max. Negotiated Rate |
$3,578.85 |
| Rate for Payer: Aetna Commercial |
$3,380.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,584.72
|
| Rate for Payer: Cash Price |
$3,181.20
|
| Rate for Payer: Cofinity Advantage |
$2,783.55
|
| Rate for Payer: Cofinity Commercial |
$3,419.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,181.20
|
| Rate for Payer: Healthscope Commercial |
$3,578.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,380.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,982.38
|
| Rate for Payer: PHP Commercial |
$3,380.03
|
| Rate for Payer: Priority Health SBD |
$2,505.20
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
IP
|
$25,160.93
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$15,851.39 |
| Max. Negotiated Rate |
$22,644.84 |
| Rate for Payer: Aetna Commercial |
$21,386.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,354.60
|
| Rate for Payer: Cash Price |
$20,128.74
|
| Rate for Payer: Cofinity Advantage |
$17,612.65
|
| Rate for Payer: Cofinity Commercial |
$21,638.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,128.74
|
| Rate for Payer: Healthscope Commercial |
$22,644.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,386.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,870.70
|
| Rate for Payer: PHP Commercial |
$21,386.79
|
| Rate for Payer: Priority Health SBD |
$15,851.39
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
OP
|
$25,160.93
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Commercial |
$21,386.79
|
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,354.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$6,695.86
|
| Rate for Payer: BCN Commercial |
$6,695.86
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Cash Price |
$20,128.74
|
| Rate for Payer: Cash Price |
$20,128.74
|
| Rate for Payer: Cash Price |
$20,128.74
|
| Rate for Payer: Cofinity Advantage |
$17,612.65
|
| Rate for Payer: Cofinity Commercial |
$21,638.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,128.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Healthscope Commercial |
$22,644.84
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,386.79
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,870.70
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Commercial |
$21,386.79
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health SBD |
$15,851.39
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
OP
|
$386.77
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$348.09 |
| Rate for Payer: Aetna Commercial |
$328.75
|
| Rate for Payer: Aetna Medicare |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.40
|
| Rate for Payer: BCBS Complete |
$154.71
|
| Rate for Payer: BCBS Trust/PPO |
$15.90
|
| Rate for Payer: BCN Commercial |
$15.90
|
| Rate for Payer: Cash Price |
$309.42
|
| Rate for Payer: Cash Price |
$309.42
|
| Rate for Payer: Cofinity Advantage |
$270.74
|
| Rate for Payer: Cofinity Commercial |
$332.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.42
|
| Rate for Payer: Healthscope Commercial |
$348.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.08
|
| Rate for Payer: PHP Commercial |
$328.75
|
| Rate for Payer: Priority Health SBD |
$243.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.40
|
| Rate for Payer: UHC Core |
$201.51
|
| Rate for Payer: UHC Exchange |
$152.00
|
|
