|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 0.5 CM OR LESS
|
Facility
|
OP
|
$838.73
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
76100089
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$712.92
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cash Price |
$670.98
|
| Rate for Payer: Cofinity Commercial |
$721.31
|
| Rate for Payer: Cofinity Commercial |
$587.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$587.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$670.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$754.86
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$712.92
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$712.92
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.17
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$528.40
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 0.6 CM TO 1.0 CM
|
Facility
|
IP
|
$600.08
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
76100090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.05 |
| Max. Negotiated Rate |
$540.07 |
| Rate for Payer: Aetna Commercial |
$510.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.05
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cofinity Commercial |
$420.06
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.06
|
| Rate for Payer: Healthscope Commercial |
$540.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.07
|
| Rate for Payer: PHP Commercial |
$510.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.05
|
| Rate for Payer: Priority Health SBD |
$378.05
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 0.6 CM TO 1.0 CM
|
Facility
|
OP
|
$600.08
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
76100090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$510.07
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Cofinity Commercial |
$420.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$540.07
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.07
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$510.07
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.05
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$378.05
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 1.1 CM TO 2.0 CM
|
Facility
|
OP
|
$1,294.26
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
76100091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$1,100.12
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$1,035.41
|
| Rate for Payer: Cash Price |
$1,035.41
|
| Rate for Payer: Cofinity Commercial |
$905.98
|
| Rate for Payer: Cofinity Commercial |
$1,113.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$905.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,035.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,164.83
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.12
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$1,100.12
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.27
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$815.38
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 1.1 CM TO 2.0 CM
|
Facility
|
IP
|
$1,294.26
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
76100091
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$815.38 |
| Max. Negotiated Rate |
$1,164.83 |
| Rate for Payer: Aetna Commercial |
$1,100.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.27
|
| Rate for Payer: Cash Price |
$1,035.41
|
| Rate for Payer: Cofinity Commercial |
$1,113.06
|
| Rate for Payer: Cofinity Commercial |
$905.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$905.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,035.41
|
| Rate for Payer: Healthscope Commercial |
$1,164.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,100.12
|
| Rate for Payer: PHP Commercial |
$1,100.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.27
|
| Rate for Payer: Priority Health SBD |
$815.38
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
IP
|
$1,176.05
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
76100092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$740.91 |
| Max. Negotiated Rate |
$1,058.44 |
| Rate for Payer: Aetna Commercial |
$999.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.43
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,011.40
|
| Rate for Payer: Cofinity Commercial |
$823.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Healthscope Commercial |
$1,058.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: PHP Commercial |
$999.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health SBD |
$740.91
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
OP
|
$1,176.05
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
76100092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$999.64
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$823.24
|
| Rate for Payer: Cofinity Commercial |
$1,011.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,058.44
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$999.64
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$740.91
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 3.1 TO 4.0 CM
|
Facility
|
IP
|
$1,411.26
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
76100093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$889.09 |
| Max. Negotiated Rate |
$1,270.13 |
| Rate for Payer: Aetna Commercial |
$1,199.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.32
|
| Rate for Payer: Cash Price |
$1,129.01
|
| Rate for Payer: Cofinity Commercial |
$1,213.68
|
| Rate for Payer: Cofinity Commercial |
$987.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$987.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.01
|
| Rate for Payer: Healthscope Commercial |
$1,270.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.57
|
| Rate for Payer: PHP Commercial |
$1,199.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.32
|
| Rate for Payer: Priority Health SBD |
$889.09
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS 3.1 TO 4.0 CM
|
Facility
|
OP
|
$1,411.26
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
76100093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$1,199.57
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,129.01
|
| Rate for Payer: Cash Price |
$1,129.01
|
| Rate for Payer: Cofinity Commercial |
$987.88
|
| Rate for Payer: Cofinity Commercial |
$1,213.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$987.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,129.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$1,270.13
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,199.57
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,199.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.32
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$889.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS OVER 4.0 CM
|
Facility
|
IP
|
$2,118.85
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
76100094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,334.88 |
| Max. Negotiated Rate |
$1,906.96 |
| Rate for Payer: Aetna Commercial |
$1,801.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,377.25
|
| Rate for Payer: Cash Price |
$1,695.08
|
| Rate for Payer: Cofinity Commercial |
$1,483.19
|
| Rate for Payer: Cofinity Commercial |
$1,822.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,483.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,695.08
|
| Rate for Payer: Healthscope Commercial |
$1,906.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,801.02
|
| Rate for Payer: PHP Commercial |
$1,801.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,377.25
|
| Rate for Payer: Priority Health SBD |
$1,334.88
|
|
|
HC EXCISE BENIGN LESION TRUNK, ARMS, LEGS OVER 4.0 CM
|
Facility
|
OP
|
$2,118.85
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
76100094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$1,801.02
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,377.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,695.08
|
| Rate for Payer: Cash Price |
$1,695.08
|
| Rate for Payer: Cofinity Commercial |
$1,822.21
|
| Rate for Payer: Cofinity Commercial |
$1,483.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,483.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,695.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$1,906.96
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,801.02
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,801.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,377.25
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$1,334.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC EXCISE CYST/BREAST LESION
|
Facility
|
OP
|
$4,727.92
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
76100230
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,001.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Commercial |
$4,018.73
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,073.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$3,782.34
|
| Rate for Payer: Cash Price |
$3,782.34
|
| Rate for Payer: Cofinity Commercial |
$4,066.01
|
| Rate for Payer: Cofinity Commercial |
$3,309.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,309.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,782.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$4,255.13
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,018.73
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$4,018.73
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,073.15
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$2,978.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,102.59
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
HC EXCISE CYST/BREAST LESION
|
Facility
|
IP
|
$4,727.92
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
76100230
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,978.59 |
| Max. Negotiated Rate |
$4,255.13 |
| Rate for Payer: Aetna Commercial |
$4,018.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,073.15
|
| Rate for Payer: Cash Price |
$3,782.34
|
| Rate for Payer: Cofinity Commercial |
$3,309.54
|
| Rate for Payer: Cofinity Commercial |
$4,066.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,309.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,782.34
|
| Rate for Payer: Healthscope Commercial |
$4,255.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,018.73
|
| Rate for Payer: PHP Commercial |
$4,018.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,073.15
|
| Rate for Payer: Priority Health SBD |
$2,978.59
|
|
|
HC EXCISE LESION EYELID WITHOUT CLOSURE
|
Facility
|
IP
|
$869.83
|
|
|
Service Code
|
CPT 67840
|
| Hospital Charge Code |
36100521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.99 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Aetna Commercial |
$739.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.39
|
| Rate for Payer: Cash Price |
$695.86
|
| Rate for Payer: Cofinity Commercial |
$608.88
|
| Rate for Payer: Cofinity Commercial |
$748.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$608.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.86
|
| Rate for Payer: Healthscope Commercial |
$782.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$739.36
|
| Rate for Payer: PHP Commercial |
$739.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.39
|
| Rate for Payer: Priority Health SBD |
$547.99
|
|
|
HC EXCISE LESION EYELID WITHOUT CLOSURE
|
Facility
|
OP
|
$869.83
|
|
|
Service Code
|
CPT 67840
|
| Hospital Charge Code |
36100521
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.31 |
| Max. Negotiated Rate |
$2,658.95 |
| Rate for Payer: Aetna Commercial |
$739.36
|
| Rate for Payer: Aetna Medicare |
$982.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,180.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,180.75
|
| Rate for Payer: BCBS Complete |
$531.62
|
| Rate for Payer: BCBS MAPPO |
$944.60
|
| Rate for Payer: BCN Medicare Advantage |
$944.60
|
| Rate for Payer: Cash Price |
$695.86
|
| Rate for Payer: Cash Price |
$695.86
|
| Rate for Payer: Cofinity Commercial |
$748.05
|
| Rate for Payer: Cofinity Commercial |
$608.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$608.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$944.60
|
| Rate for Payer: Healthscope Commercial |
$782.85
|
| Rate for Payer: Mclaren Medicaid |
$506.31
|
| Rate for Payer: Mclaren Medicare |
$944.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$991.83
|
| Rate for Payer: Meridian Medicaid |
$531.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,086.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$739.36
|
| Rate for Payer: PACE Medicare |
$897.37
|
| Rate for Payer: PACE SWMI |
$944.60
|
| Rate for Payer: PHP Commercial |
$739.36
|
| Rate for Payer: PHP Medicare Advantage |
$944.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$506.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$565.39
|
| Rate for Payer: Priority Health Medicare |
$944.60
|
| Rate for Payer: Priority Health SBD |
$547.99
|
| Rate for Payer: Railroad Medicare Medicare |
$944.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,658.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$944.60
|
| Rate for Payer: UHC Medicare Advantage |
$944.60
|
| Rate for Payer: UHCCP Medicaid |
$531.81
|
| Rate for Payer: VA VA |
$944.60
|
|
|
HC EXCISE LESION MUCOSA & SBMCSL VESTIB CPLX RPR
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 40814
|
| Hospital Charge Code |
76100490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,237.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Cofinity Commercial |
$5,640.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,640.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Priority Health SBD |
$5,076.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,780.71
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
HC EXCISE LESION MUCOSA & SBMCSL VESTIB CPLX RPR
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 40814
|
| Hospital Charge Code |
76100490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,076.54 |
| Max. Negotiated Rate |
$7,252.20 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,237.70
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$5,640.60
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,640.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health SBD |
$5,076.54
|
|
|
HC EXCISE LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
76100461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,237.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Cofinity Commercial |
$5,640.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,640.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Priority Health SBD |
$5,076.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,780.71
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
HC EXCISE LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 40810
|
| Hospital Charge Code |
76100461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,076.54 |
| Max. Negotiated Rate |
$7,252.20 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,237.70
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$5,640.60
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,640.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health SBD |
$5,076.54
|
|
|
HC EXCISE LIP OR CHEEK FOLD
|
Facility
|
OP
|
$3,964.53
|
|
|
Service Code
|
CPT 40819
|
| Hospital Charge Code |
76100517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.34 |
| Max. Negotiated Rate |
$4,066.57 |
| Rate for Payer: Aetna Commercial |
$3,369.85
|
| Rate for Payer: Aetna Medicare |
$1,502.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,576.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,805.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,805.83
|
| Rate for Payer: BCBS Complete |
$813.05
|
| Rate for Payer: BCBS MAPPO |
$1,444.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.66
|
| Rate for Payer: Cash Price |
$3,171.62
|
| Rate for Payer: Cash Price |
$3,171.62
|
| Rate for Payer: Cofinity Commercial |
$3,409.50
|
| Rate for Payer: Cofinity Commercial |
$2,775.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,775.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,171.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.66
|
| Rate for Payer: Healthscope Commercial |
$3,568.08
|
| Rate for Payer: Mclaren Medicaid |
$774.34
|
| Rate for Payer: Mclaren Medicare |
$1,444.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.89
|
| Rate for Payer: Meridian Medicaid |
$813.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,661.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,369.85
|
| Rate for Payer: PACE Medicare |
$1,372.43
|
| Rate for Payer: PACE SWMI |
$1,444.66
|
| Rate for Payer: PHP Commercial |
$3,369.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,576.94
|
| Rate for Payer: Priority Health Medicare |
$1,444.66
|
| Rate for Payer: Priority Health SBD |
$2,497.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,066.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,444.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,444.66
|
| Rate for Payer: UHCCP Medicaid |
$813.34
|
| Rate for Payer: VA VA |
$1,444.66
|
|
|
HC EXCISE LIP OR CHEEK FOLD
|
Facility
|
IP
|
$3,964.53
|
|
|
Service Code
|
CPT 40819
|
| Hospital Charge Code |
76100517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,497.65 |
| Max. Negotiated Rate |
$3,568.08 |
| Rate for Payer: Aetna Commercial |
$3,369.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,576.94
|
| Rate for Payer: Cash Price |
$3,171.62
|
| Rate for Payer: Cofinity Commercial |
$2,775.17
|
| Rate for Payer: Cofinity Commercial |
$3,409.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,775.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,171.62
|
| Rate for Payer: Healthscope Commercial |
$3,568.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,369.85
|
| Rate for Payer: PHP Commercial |
$3,369.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,576.94
|
| Rate for Payer: Priority Health SBD |
$2,497.65
|
|
|
HC EXCISE MALIGNANT LESION FACE, EARS, EYELIDS, NOSE, LIPS 0.5 CM OR LESS
|
Facility
|
OP
|
$1,176.05
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
76100110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$999.64
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$823.24
|
| Rate for Payer: Cofinity Commercial |
$1,011.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,058.44
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$999.64
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$740.91
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC EXCISE MALIGNANT LESION FACE, EARS, EYELIDS, NOSE, LIPS 0.5 CM OR LESS
|
Facility
|
IP
|
$1,176.05
|
|
|
Service Code
|
CPT 11640
|
| Hospital Charge Code |
76100110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$740.91 |
| Max. Negotiated Rate |
$1,058.44 |
| Rate for Payer: Aetna Commercial |
$999.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.43
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,011.40
|
| Rate for Payer: Cofinity Commercial |
$823.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Healthscope Commercial |
$1,058.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: PHP Commercial |
$999.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health SBD |
$740.91
|
|
|
HC EXCISE MALIGNANT LESION FACE, EARS, EYELIDS, NOSE, LIPS 0.6 TO 1.0 CM
|
Facility
|
IP
|
$600.08
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
76100111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.05 |
| Max. Negotiated Rate |
$540.07 |
| Rate for Payer: Aetna Commercial |
$510.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.05
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cofinity Commercial |
$420.06
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.06
|
| Rate for Payer: Healthscope Commercial |
$540.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.07
|
| Rate for Payer: PHP Commercial |
$510.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.05
|
| Rate for Payer: Priority Health SBD |
$378.05
|
|
|
HC EXCISE MALIGNANT LESION FACE, EARS, EYELIDS, NOSE, LIPS 0.6 TO 1.0 CM
|
Facility
|
OP
|
$600.08
|
|
|
Service Code
|
CPT 11641
|
| Hospital Charge Code |
76100111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$510.07
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cash Price |
$480.06
|
| Rate for Payer: Cofinity Commercial |
$516.07
|
| Rate for Payer: Cofinity Commercial |
$420.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$420.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$480.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$540.07
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$510.07
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$510.07
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.05
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$378.05
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
