|
HC DEGLYCEROLIZED RED BLOOD CELLS
|
Facility
|
OP
|
$944.06
|
|
|
Service Code
|
HCPCS P9039
|
| Hospital Charge Code |
39000049
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$343.32 |
| Max. Negotiated Rate |
$992.81 |
| Rate for Payer: Aetna Commercial |
$849.65
|
| Rate for Payer: Aetna Medicare |
$640.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$800.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$800.65
|
| Rate for Payer: ASR ASR |
$915.74
|
| Rate for Payer: ASR Commercial |
$915.74
|
| Rate for Payer: BCBS Complete |
$360.48
|
| Rate for Payer: BCBS MAPPO |
$640.52
|
| Rate for Payer: BCBS Trust/PPO |
$773.09
|
| Rate for Payer: BCN Commercial |
$731.93
|
| Rate for Payer: BCN Medicare Advantage |
$640.52
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cash Price |
$755.25
|
| Rate for Payer: Cofinity Commercial |
$887.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.52
|
| Rate for Payer: Healthscope Commercial |
$944.06
|
| Rate for Payer: Healthscope Whirlpool |
$915.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$640.52
|
| Rate for Payer: Mclaren Commercial |
$849.65
|
| Rate for Payer: Mclaren Medicaid |
$343.32
|
| Rate for Payer: Mclaren Medicare |
$640.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.55
|
| Rate for Payer: Meridian Medicaid |
$360.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$736.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.45
|
| Rate for Payer: Nomi Health Commercial |
$774.13
|
| Rate for Payer: PACE Medicare |
$608.49
|
| Rate for Payer: PACE SWMI |
$640.52
|
| Rate for Payer: PHP Commercial |
$704.57
|
| Rate for Payer: PHP Medicaid |
$343.32
|
| Rate for Payer: PHP Medicare Advantage |
$640.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.19
|
| Rate for Payer: Priority Health Medicare |
$640.52
|
| Rate for Payer: Priority Health Narrow Network |
$661.79
|
| Rate for Payer: Railroad Medicare Medicare |
$640.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$830.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.52
|
| Rate for Payer: UHC Exchange |
$992.81
|
| Rate for Payer: UHC Medicare Advantage |
$640.52
|
| Rate for Payer: UHCCP DNSP |
$640.52
|
| Rate for Payer: UHCCP Medicaid |
$343.32
|
| Rate for Payer: VA VA |
$640.52
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
OP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.64 |
| Max. Negotiated Rate |
$5,205.06 |
| Rate for Payer: Aetna Commercial |
$4,684.55
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: ASR ASR |
$5,048.91
|
| Rate for Payer: ASR Commercial |
$5,048.91
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,262.42
|
| Rate for Payer: BCN Commercial |
$4,035.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$4,892.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$5,205.06
|
| Rate for Payer: Healthscope Whirlpool |
$5,048.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$4,684.55
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: Nomi Health Commercial |
$4,268.15
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,560.67
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$3,648.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,580.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS
|
Facility
|
IP
|
$5,205.06
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
76100415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,383.29 |
| Max. Negotiated Rate |
$5,205.06 |
| Rate for Payer: Aetna Commercial |
$4,684.55
|
| Rate for Payer: ASR ASR |
$5,048.91
|
| Rate for Payer: ASR Commercial |
$5,048.91
|
| Rate for Payer: BCBS Trust/PPO |
$4,241.60
|
| Rate for Payer: BCN Commercial |
$4,035.48
|
| Rate for Payer: Cash Price |
$4,164.05
|
| Rate for Payer: Cofinity Commercial |
$4,892.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,164.05
|
| Rate for Payer: Healthscope Commercial |
$5,205.06
|
| Rate for Payer: Healthscope Whirlpool |
$5,048.91
|
| Rate for Payer: Mclaren Commercial |
$4,684.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,424.30
|
| Rate for Payer: Nomi Health Commercial |
$4,268.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,383.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,580.45
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
IP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$544.18 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna Commercial |
$753.48
|
| Rate for Payer: ASR ASR |
$812.08
|
| Rate for Payer: ASR Commercial |
$812.08
|
| Rate for Payer: BCBS Trust/PPO |
$682.23
|
| Rate for Payer: BCN Commercial |
$649.08
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$786.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Healthscope Commercial |
$837.20
|
| Rate for Payer: Healthscope Whirlpool |
$812.08
|
| Rate for Payer: Mclaren Commercial |
$753.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: Nomi Health Commercial |
$686.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$736.74
|
|
|
HC DELIVERY/BIRTH RM RESUSCITATION
|
Facility
|
OP
|
$837.20
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
72000011
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$340.82 |
| Max. Negotiated Rate |
$993.78 |
| Rate for Payer: Aetna Commercial |
$753.48
|
| Rate for Payer: Aetna Medicare |
$641.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$801.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$801.44
|
| Rate for Payer: ASR ASR |
$812.08
|
| Rate for Payer: ASR Commercial |
$812.08
|
| Rate for Payer: BCBS Complete |
$360.84
|
| Rate for Payer: BCBS MAPPO |
$641.15
|
| Rate for Payer: BCBS Trust/PPO |
$685.58
|
| Rate for Payer: BCN Commercial |
$649.08
|
| Rate for Payer: BCN Medicare Advantage |
$641.15
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cash Price |
$669.76
|
| Rate for Payer: Cofinity Commercial |
$786.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$669.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.15
|
| Rate for Payer: Healthscope Commercial |
$837.20
|
| Rate for Payer: Healthscope Whirlpool |
$812.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$641.15
|
| Rate for Payer: Mclaren Commercial |
$753.48
|
| Rate for Payer: Mclaren Medicaid |
$343.66
|
| Rate for Payer: Mclaren Medicare |
$641.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.21
|
| Rate for Payer: Meridian Medicaid |
$360.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$711.62
|
| Rate for Payer: Nomi Health Commercial |
$686.50
|
| Rate for Payer: PACE Medicare |
$609.09
|
| Rate for Payer: PACE SWMI |
$641.15
|
| Rate for Payer: PHP Commercial |
$705.26
|
| Rate for Payer: PHP Medicaid |
$343.66
|
| Rate for Payer: PHP Medicare Advantage |
$641.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.03
|
| Rate for Payer: Priority Health Medicare |
$641.15
|
| Rate for Payer: Priority Health Narrow Network |
$340.82
|
| Rate for Payer: Railroad Medicare Medicare |
$641.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$736.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.15
|
| Rate for Payer: UHC Exchange |
$993.78
|
| Rate for Payer: UHC Medicare Advantage |
$641.15
|
| Rate for Payer: UHCCP DNSP |
$641.15
|
| Rate for Payer: UHCCP Medicaid |
$343.66
|
| Rate for Payer: VA VA |
$641.15
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
OP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$83.45 |
| Max. Negotiated Rate |
$308.88 |
| Rate for Payer: Aetna Commercial |
$220.44
|
| Rate for Payer: Aetna Medicare |
$199.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.10
|
| Rate for Payer: ASR ASR |
$237.58
|
| Rate for Payer: ASR Commercial |
$237.58
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS MAPPO |
$199.28
|
| Rate for Payer: BCBS Trust/PPO |
$200.57
|
| Rate for Payer: BCN Commercial |
$189.89
|
| Rate for Payer: BCN Medicare Advantage |
$199.28
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$230.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$244.93
|
| Rate for Payer: Healthscope Whirlpool |
$237.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.28
|
| Rate for Payer: Mclaren Commercial |
$220.44
|
| Rate for Payer: Mclaren Medicaid |
$106.81
|
| Rate for Payer: Mclaren Medicare |
$199.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.24
|
| Rate for Payer: Meridian Medicaid |
$112.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: PACE Medicare |
$189.32
|
| Rate for Payer: PACE SWMI |
$199.28
|
| Rate for Payer: PHP Commercial |
$219.21
|
| Rate for Payer: PHP Medicaid |
$106.81
|
| Rate for Payer: PHP Medicare Advantage |
$199.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.31
|
| Rate for Payer: Priority Health Medicare |
$199.28
|
| Rate for Payer: Priority Health Narrow Network |
$83.45
|
| Rate for Payer: Railroad Medicare Medicare |
$199.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.28
|
| Rate for Payer: UHC Exchange |
$308.88
|
| Rate for Payer: UHC Medicare Advantage |
$199.28
|
| Rate for Payer: UHCCP DNSP |
$199.28
|
| Rate for Payer: UHCCP Medicaid |
$106.81
|
| Rate for Payer: VA VA |
$199.28
|
|
|
HC DEMO EVAL NEB MDI IPPB
|
Facility
|
IP
|
$244.93
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
41000009
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$244.93 |
| Rate for Payer: Aetna Commercial |
$220.44
|
| Rate for Payer: ASR ASR |
$237.58
|
| Rate for Payer: ASR Commercial |
$237.58
|
| Rate for Payer: BCBS Trust/PPO |
$199.59
|
| Rate for Payer: BCN Commercial |
$189.89
|
| Rate for Payer: Cash Price |
$195.94
|
| Rate for Payer: Cofinity Commercial |
$230.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.94
|
| Rate for Payer: Healthscope Commercial |
$244.93
|
| Rate for Payer: Healthscope Whirlpool |
$237.58
|
| Rate for Payer: Mclaren Commercial |
$220.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.19
|
| Rate for Payer: Nomi Health Commercial |
$200.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.54
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
OP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$586.39 |
| Rate for Payer: Aetna Commercial |
$527.75
|
| Rate for Payer: Aetna Medicare |
$126.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.82
|
| Rate for Payer: ASR ASR |
$568.80
|
| Rate for Payer: ASR Commercial |
$568.80
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS MAPPO |
$126.26
|
| Rate for Payer: BCBS Trust/PPO |
$480.19
|
| Rate for Payer: BCN Commercial |
$454.63
|
| Rate for Payer: BCN Medicare Advantage |
$126.26
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$551.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.26
|
| Rate for Payer: Healthscope Commercial |
$586.39
|
| Rate for Payer: Healthscope Whirlpool |
$568.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$126.26
|
| Rate for Payer: Mclaren Commercial |
$527.75
|
| Rate for Payer: Mclaren Medicaid |
$67.68
|
| Rate for Payer: Mclaren Medicare |
$126.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.57
|
| Rate for Payer: Meridian Medicaid |
$71.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: Nomi Health Commercial |
$480.84
|
| Rate for Payer: PACE Medicare |
$119.95
|
| Rate for Payer: PACE SWMI |
$126.26
|
| Rate for Payer: PHP Commercial |
$138.89
|
| Rate for Payer: PHP Medicaid |
$67.68
|
| Rate for Payer: PHP Medicare Advantage |
$126.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.79
|
| Rate for Payer: Priority Health Medicare |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$411.06
|
| Rate for Payer: Railroad Medicare Medicare |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$516.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.26
|
| Rate for Payer: UHC Exchange |
$195.70
|
| Rate for Payer: UHC Medicare Advantage |
$126.26
|
| Rate for Payer: UHCCP DNSP |
$126.26
|
| Rate for Payer: UHCCP Medicaid |
$67.68
|
| Rate for Payer: VA VA |
$126.26
|
|
|
HC DEMO HOME USE INR MONITOR
|
Facility
|
IP
|
$586.39
|
|
|
Service Code
|
HCPCS G0248
|
| Hospital Charge Code |
51000042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.15 |
| Max. Negotiated Rate |
$586.39 |
| Rate for Payer: Aetna Commercial |
$527.75
|
| Rate for Payer: ASR ASR |
$568.80
|
| Rate for Payer: ASR Commercial |
$568.80
|
| Rate for Payer: BCBS Trust/PPO |
$477.85
|
| Rate for Payer: BCN Commercial |
$454.63
|
| Rate for Payer: Cash Price |
$469.11
|
| Rate for Payer: Cofinity Commercial |
$551.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.11
|
| Rate for Payer: Healthscope Commercial |
$586.39
|
| Rate for Payer: Healthscope Whirlpool |
$568.80
|
| Rate for Payer: Mclaren Commercial |
$527.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.43
|
| Rate for Payer: Nomi Health Commercial |
$480.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$516.02
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$561.86
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$561.86 |
| Rate for Payer: Aetna Commercial |
$505.67
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$545.00
|
| Rate for Payer: ASR Commercial |
$545.00
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$460.11
|
| Rate for Payer: BCN Commercial |
$435.61
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cofinity Commercial |
$528.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$561.86
|
| Rate for Payer: Healthscope Whirlpool |
$545.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$505.67
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.58
|
| Rate for Payer: Nomi Health Commercial |
$460.73
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$492.30
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$393.86
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$561.86
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.21 |
| Max. Negotiated Rate |
$561.86 |
| Rate for Payer: Aetna Commercial |
$505.67
|
| Rate for Payer: ASR ASR |
$545.00
|
| Rate for Payer: ASR Commercial |
$545.00
|
| Rate for Payer: BCBS Trust/PPO |
$457.86
|
| Rate for Payer: BCN Commercial |
$435.61
|
| Rate for Payer: Cash Price |
$449.49
|
| Rate for Payer: Cofinity Commercial |
$528.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.49
|
| Rate for Payer: Healthscope Commercial |
$561.86
|
| Rate for Payer: Healthscope Whirlpool |
$545.00
|
| Rate for Payer: Mclaren Commercial |
$505.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.58
|
| Rate for Payer: Nomi Health Commercial |
$460.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.44
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
OP
|
$85.56
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Aetna Medicare |
$42.78
|
| Rate for Payer: ASR ASR |
$82.99
|
| Rate for Payer: ASR Commercial |
$82.99
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS Trust/PPO |
$70.07
|
| Rate for Payer: BCN Commercial |
$66.33
|
| Rate for Payer: Cash Price |
$68.45
|
| Rate for Payer: Cash Price |
$68.45
|
| Rate for Payer: Cofinity Commercial |
$80.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.45
|
| Rate for Payer: Healthscope Commercial |
$85.56
|
| Rate for Payer: Healthscope Whirlpool |
$82.99
|
| Rate for Payer: Mclaren Commercial |
$77.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.73
|
| Rate for Payer: Nomi Health Commercial |
$70.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.64
|
| Rate for Payer: Priority Health Narrow Network |
$37.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.29
|
|
|
HC DERMAGRAFT PER SQ CM
|
Facility
|
IP
|
$85.56
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
63600004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.61 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: ASR ASR |
$82.99
|
| Rate for Payer: ASR Commercial |
$82.99
|
| Rate for Payer: BCBS Trust/PPO |
$69.72
|
| Rate for Payer: BCN Commercial |
$66.33
|
| Rate for Payer: Cash Price |
$68.45
|
| Rate for Payer: Cofinity Commercial |
$80.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.45
|
| Rate for Payer: Healthscope Commercial |
$85.56
|
| Rate for Payer: Healthscope Whirlpool |
$82.99
|
| Rate for Payer: Mclaren Commercial |
$77.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.73
|
| Rate for Payer: Nomi Health Commercial |
$70.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.29
|
|
|
HC DES ADD.BRANCH
|
Facility
|
OP
|
$17,010.57
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,804.23 |
| Max. Negotiated Rate |
$17,010.57 |
| Rate for Payer: Aetna Commercial |
$15,309.51
|
| Rate for Payer: Aetna Medicare |
$8,505.28
|
| Rate for Payer: ASR ASR |
$16,500.25
|
| Rate for Payer: ASR Commercial |
$16,500.25
|
| Rate for Payer: BCBS Complete |
$6,804.23
|
| Rate for Payer: BCBS Trust/PPO |
$13,929.96
|
| Rate for Payer: BCN Commercial |
$13,188.29
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$15,989.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$17,010.57
|
| Rate for Payer: Healthscope Whirlpool |
$16,500.25
|
| Rate for Payer: Mclaren Commercial |
$15,309.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,888.06
|
| Rate for Payer: Priority Health Narrow Network |
$7,110.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,969.30
|
|
|
HC DES ADD.BRANCH
|
Facility
|
IP
|
$17,010.57
|
|
|
Service Code
|
CPT C9601
|
| Hospital Charge Code |
48100076
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,056.87 |
| Max. Negotiated Rate |
$17,010.57 |
| Rate for Payer: Aetna Commercial |
$15,309.51
|
| Rate for Payer: ASR ASR |
$16,500.25
|
| Rate for Payer: ASR Commercial |
$16,500.25
|
| Rate for Payer: BCBS Trust/PPO |
$13,861.91
|
| Rate for Payer: BCN Commercial |
$13,188.29
|
| Rate for Payer: Cash Price |
$13,608.46
|
| Rate for Payer: Cofinity Commercial |
$15,989.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,608.46
|
| Rate for Payer: Healthscope Commercial |
$17,010.57
|
| Rate for Payer: Healthscope Whirlpool |
$16,500.25
|
| Rate for Payer: Mclaren Commercial |
$15,309.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,458.98
|
| Rate for Payer: Nomi Health Commercial |
$13,948.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,056.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,969.30
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
IP
|
$8,109.00
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,270.85 |
| Max. Negotiated Rate |
$8,109.00 |
| Rate for Payer: Aetna Commercial |
$7,298.10
|
| Rate for Payer: ASR ASR |
$7,865.73
|
| Rate for Payer: ASR Commercial |
$7,865.73
|
| Rate for Payer: BCBS Trust/PPO |
$6,608.02
|
| Rate for Payer: BCN Commercial |
$6,286.91
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$7,622.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Healthscope Commercial |
$8,109.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,865.73
|
| Rate for Payer: Mclaren Commercial |
$7,298.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,135.92
|
|
|
HC DESTR LESION ROOF OF MOUTH
|
Facility
|
OP
|
$8,109.00
|
|
|
Service Code
|
CPT 42160
|
| Hospital Charge Code |
76100393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,703.14 |
| Max. Negotiated Rate |
$8,109.00 |
| Rate for Payer: Aetna Commercial |
$7,298.10
|
| Rate for Payer: Aetna Medicare |
$3,177.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: ASR ASR |
$7,865.73
|
| Rate for Payer: ASR Commercial |
$7,865.73
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,640.46
|
| Rate for Payer: BCN Commercial |
$6,286.91
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cash Price |
$6,487.20
|
| Rate for Payer: Cofinity Commercial |
$7,622.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,487.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$8,109.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,865.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,177.50
|
| Rate for Payer: Mclaren Commercial |
$7,298.10
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Commercial |
$3,495.25
|
| Rate for Payer: PHP Medicaid |
$1,703.14
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,270.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,105.11
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$5,684.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,135.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$4,925.12
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP DNSP |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
OP
|
$242.62
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$218.36
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$235.34
|
| Rate for Payer: ASR Commercial |
$235.34
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$198.68
|
| Rate for Payer: BCN Commercial |
$188.10
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cofinity Commercial |
$228.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Healthscope Whirlpool |
$235.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$218.36
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.23
|
| Rate for Payer: Nomi Health Commercial |
$198.95
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.58
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$170.08
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM <0.6 CM
|
Facility
|
IP
|
$242.62
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.70 |
| Max. Negotiated Rate |
$242.62 |
| Rate for Payer: Aetna Commercial |
$218.36
|
| Rate for Payer: ASR ASR |
$235.34
|
| Rate for Payer: ASR Commercial |
$235.34
|
| Rate for Payer: BCBS Trust/PPO |
$197.71
|
| Rate for Payer: BCN Commercial |
$188.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cofinity Commercial |
$228.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.10
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Healthscope Whirlpool |
$235.34
|
| Rate for Payer: Mclaren Commercial |
$218.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.23
|
| Rate for Payer: Nomi Health Commercial |
$198.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.51
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
OP
|
$392.23
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$392.23 |
| Rate for Payer: Aetna Commercial |
$353.01
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$380.46
|
| Rate for Payer: ASR Commercial |
$380.46
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$321.20
|
| Rate for Payer: BCN Commercial |
$304.10
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$368.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$392.23
|
| Rate for Payer: Healthscope Whirlpool |
$380.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$353.01
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.67
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$274.95
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 0.6 TO 1.0 CM
|
Facility
|
IP
|
$392.23
|
|
|
Service Code
|
CPT 17281
|
| Hospital Charge Code |
76100147
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.95 |
| Max. Negotiated Rate |
$392.23 |
| Rate for Payer: Aetna Commercial |
$353.01
|
| Rate for Payer: ASR ASR |
$380.46
|
| Rate for Payer: ASR Commercial |
$380.46
|
| Rate for Payer: BCBS Trust/PPO |
$319.63
|
| Rate for Payer: BCN Commercial |
$304.10
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$368.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Healthscope Commercial |
$392.23
|
| Rate for Payer: Healthscope Whirlpool |
$380.46
|
| Rate for Payer: Mclaren Commercial |
$353.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.16
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 2.1-3 CM
|
Facility
|
OP
|
$392.23
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$353.01
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$380.46
|
| Rate for Payer: ASR Commercial |
$380.46
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$321.20
|
| Rate for Payer: BCN Commercial |
$304.10
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$368.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$392.23
|
| Rate for Payer: Healthscope Whirlpool |
$380.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$353.01
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.67
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$274.95
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 2.1-3 CM
|
Facility
|
IP
|
$392.23
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$254.95 |
| Max. Negotiated Rate |
$392.23 |
| Rate for Payer: Aetna Commercial |
$353.01
|
| Rate for Payer: ASR ASR |
$380.46
|
| Rate for Payer: ASR Commercial |
$380.46
|
| Rate for Payer: BCBS Trust/PPO |
$319.63
|
| Rate for Payer: BCN Commercial |
$304.10
|
| Rate for Payer: Cash Price |
$313.78
|
| Rate for Payer: Cofinity Commercial |
$368.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.78
|
| Rate for Payer: Healthscope Commercial |
$392.23
|
| Rate for Payer: Healthscope Whirlpool |
$380.46
|
| Rate for Payer: Mclaren Commercial |
$353.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.16
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 3.1-4 CM
|
Facility
|
OP
|
$602.39
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.47 |
| Max. Negotiated Rate |
$929.61 |
| Rate for Payer: Aetna Commercial |
$542.15
|
| Rate for Payer: Aetna Medicare |
$599.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: ASR ASR |
$584.32
|
| Rate for Payer: ASR Commercial |
$584.32
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$493.30
|
| Rate for Payer: BCN Commercial |
$467.03
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$566.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$602.39
|
| Rate for Payer: Healthscope Whirlpool |
$584.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$599.75
|
| Rate for Payer: Mclaren Commercial |
$542.15
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: Nomi Health Commercial |
$493.96
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$659.72
|
| Rate for Payer: PHP Medicaid |
$321.47
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.81
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$422.28
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$530.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$929.61
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP DNSP |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: VA VA |
$599.75
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM 3.1-4 CM
|
Facility
|
IP
|
$602.39
|
|
|
Service Code
|
CPT 17284
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.55 |
| Max. Negotiated Rate |
$602.39 |
| Rate for Payer: Aetna Commercial |
$542.15
|
| Rate for Payer: ASR ASR |
$584.32
|
| Rate for Payer: ASR Commercial |
$584.32
|
| Rate for Payer: BCBS Trust/PPO |
$490.89
|
| Rate for Payer: BCN Commercial |
$467.03
|
| Rate for Payer: Cash Price |
$481.91
|
| Rate for Payer: Cofinity Commercial |
$566.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.91
|
| Rate for Payer: Healthscope Commercial |
$602.39
|
| Rate for Payer: Healthscope Whirlpool |
$584.32
|
| Rate for Payer: Mclaren Commercial |
$542.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: Nomi Health Commercial |
$493.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$530.10
|
|
