|
HC DESTRUCT MALIG LESION FACE,EAR,EYELID,NOSE,LIP, MUC MEMB 1.1 TO 2.0 CM
|
Facility
|
OP
|
$384.54
|
|
|
Service Code
|
CPT 17282
|
| Hospital Charge Code |
76100131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$346.09
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$373.00
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$298.13
|
| Rate for Payer: BCN Commercial |
$298.13
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$307.63
|
| Rate for Payer: Cash Price |
$307.63
|
| Rate for Payer: Cofinity Commercial |
$361.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$384.54
|
| Rate for Payer: Healthscope Whirlpool |
$373.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$346.09
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$326.86
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$349.93
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$273.02
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.40
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA <0.6 CM
|
Facility
|
OP
|
$215.22
|
|
|
Service Code
|
CPT 17270
|
| Hospital Charge Code |
76100154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$193.70
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$208.76
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$166.86
|
| Rate for Payer: BCN Commercial |
$166.86
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cofinity Commercial |
$202.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$215.22
|
| Rate for Payer: Healthscope Whirlpool |
$208.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$193.70
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.94
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.85
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$152.81
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.39
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA <0.6 CM
|
Facility
|
IP
|
$215.22
|
|
|
Service Code
|
CPT 17270
|
| Hospital Charge Code |
76100154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$215.22 |
| Rate for Payer: Aetna Commercial |
$193.70
|
| Rate for Payer: ASR ASR |
$208.76
|
| Rate for Payer: BCBS Trust/PPO |
$166.86
|
| Rate for Payer: BCN Commercial |
$166.86
|
| Rate for Payer: Cash Price |
$172.18
|
| Rate for Payer: Cofinity Commercial |
$202.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.18
|
| Rate for Payer: Healthscope Commercial |
$215.22
|
| Rate for Payer: Healthscope Whirlpool |
$208.76
|
| Rate for Payer: Mclaren Commercial |
$193.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.39
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.6 TO 1.0 CM
|
Facility
|
OP
|
$276.07
|
|
|
Service Code
|
CPT 17271
|
| Hospital Charge Code |
76100128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$276.07 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.22
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$196.01
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.6 TO 1.0 CM
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 17271
|
| Hospital Charge Code |
76100128
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$276.07 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.1 TO 2.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 17272
|
| Hospital Charge Code |
76100129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.37
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$112.64
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.1 TO 2.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 17272
|
| Hospital Charge Code |
76100129
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA 2.1 TO 3.0 CM
|
Facility
|
OP
|
$303.68
|
|
|
Service Code
|
CPT 17273
|
| Hospital Charge Code |
76100130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$294.57
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$235.44
|
| Rate for Payer: BCN Commercial |
$235.44
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$285.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$303.68
|
| Rate for Payer: Healthscope Whirlpool |
$294.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$273.31
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.35
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$215.61
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.24
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC DESTRUCT MALIG LESION SCALP, NECK, HANDS, FEET, GENITALIA 2.1 TO 3.0 CM
|
Facility
|
IP
|
$303.68
|
|
|
Service Code
|
CPT 17273
|
| Hospital Charge Code |
76100130
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.58 |
| Max. Negotiated Rate |
$303.68 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: ASR ASR |
$294.57
|
| Rate for Payer: BCBS Trust/PPO |
$235.44
|
| Rate for Payer: BCN Commercial |
$235.44
|
| Rate for Payer: Cash Price |
$242.94
|
| Rate for Payer: Cofinity Commercial |
$285.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.94
|
| Rate for Payer: Healthscope Commercial |
$303.68
|
| Rate for Payer: Healthscope Whirlpool |
$294.57
|
| Rate for Payer: Mclaren Commercial |
$273.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$267.24
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.5 CM OR LESS
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
76100125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.37
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$112.64
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.5 CM OR LESS
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 17260
|
| Hospital Charge Code |
76100125
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.6 TO 1.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 0.6 TO 1.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 17261
|
| Hospital Charge Code |
76100126
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.37
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$112.64
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
76100127
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.37
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$112.64
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: ASR ASR |
$506.34
|
| Rate for Payer: BCBS Trust/PPO |
$404.71
|
| Rate for Payer: BCN Commercial |
$404.71
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cofinity Commercial |
$490.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.60
|
| Rate for Payer: Healthscope Commercial |
$522.00
|
| Rate for Payer: Healthscope Whirlpool |
$506.34
|
| Rate for Payer: Mclaren Commercial |
$469.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$443.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.36
|
|
|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$506.34
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$404.71
|
| Rate for Payer: BCN Commercial |
$404.71
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cofinity Commercial |
$490.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$522.00
|
| Rate for Payer: Healthscope Whirlpool |
$506.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$469.80
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$443.70
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.02
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$370.62
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.36
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV
|
Facility
|
OP
|
$400.86
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
36100608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$400.86 |
| Rate for Payer: Aetna Commercial |
$360.77
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$388.83
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$310.79
|
| Rate for Payer: BCN Commercial |
$310.79
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$320.69
|
| Rate for Payer: Cash Price |
$320.69
|
| Rate for Payer: Cofinity Commercial |
$376.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$400.86
|
| Rate for Payer: Healthscope Whirlpool |
$388.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$360.77
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.73
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.78
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$284.61
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.76
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV
|
Facility
|
IP
|
$400.86
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
36100608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.60 |
| Max. Negotiated Rate |
$400.86 |
| Rate for Payer: Aetna Commercial |
$360.77
|
| Rate for Payer: ASR ASR |
$388.83
|
| Rate for Payer: BCBS Trust/PPO |
$310.79
|
| Rate for Payer: BCN Commercial |
$310.79
|
| Rate for Payer: Cash Price |
$320.69
|
| Rate for Payer: Cofinity Commercial |
$376.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.69
|
| Rate for Payer: Healthscope Commercial |
$400.86
|
| Rate for Payer: Healthscope Whirlpool |
$388.83
|
| Rate for Payer: Mclaren Commercial |
$360.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.76
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
OP
|
$276.07
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.22
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$196.01
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$276.07 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
OP
|
$173.07
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$155.76
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$167.88
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$134.18
|
| Rate for Payer: BCN Commercial |
$134.18
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$138.46
|
| Rate for Payer: Cash Price |
$138.46
|
| Rate for Payer: Cofinity Commercial |
$162.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$173.07
|
| Rate for Payer: Healthscope Whirlpool |
$167.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$155.76
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.11
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.49
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$122.88
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.30
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
IP
|
$173.07
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.15 |
| Max. Negotiated Rate |
$173.07 |
| Rate for Payer: Aetna Commercial |
$155.76
|
| Rate for Payer: ASR ASR |
$167.88
|
| Rate for Payer: BCBS Trust/PPO |
$134.18
|
| Rate for Payer: BCN Commercial |
$134.18
|
| Rate for Payer: Cash Price |
$138.46
|
| Rate for Payer: Cofinity Commercial |
$162.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.46
|
| Rate for Payer: Healthscope Commercial |
$173.07
|
| Rate for Payer: Healthscope Whirlpool |
$167.88
|
| Rate for Payer: Mclaren Commercial |
$155.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.30
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
OP
|
$34.78
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$34.78 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: ASR ASR |
$33.74
|
| Rate for Payer: BCBS Complete |
$13.91
|
| Rate for Payer: BCBS Trust/PPO |
$26.96
|
| Rate for Payer: BCN Commercial |
$26.96
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$32.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$34.78
|
| Rate for Payer: Healthscope Whirlpool |
$33.74
|
| Rate for Payer: Mclaren Commercial |
$31.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.65
|
| Rate for Payer: Priority Health Narrow Network |
$24.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.61
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
IP
|
$34.78
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$34.78 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: ASR ASR |
$33.74
|
| Rate for Payer: BCBS Trust/PPO |
$26.96
|
| Rate for Payer: BCN Commercial |
$26.96
|
| Rate for Payer: Cash Price |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$32.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.82
|
| Rate for Payer: Healthscope Commercial |
$34.78
|
| Rate for Payer: Healthscope Whirlpool |
$33.74
|
| Rate for Payer: Mclaren Commercial |
$31.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.61
|
|
