|
HC DENTAL NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$561.86
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
45000014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$561.86 |
| Rate for Payer: Aetna Commercial |
$505.67
|
| Rate for Payer: Aetna Medicare |
$287.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: ASR ASR |
$545.00
|
| Rate for Payer: ASR Commercial |
$545.00
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$460.11
|
| Rate for Payer: BCN Commercial |
$435.61
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| 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 |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$561.86
|
| Rate for Payer: Healthscope Whirlpool |
$545.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$505.67
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.58
|
| Rate for Payer: Nomi Health Commercial |
$460.73
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$316.68
|
| Rate for Payer: PHP Medicaid |
$154.31
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| 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 |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$393.86
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$446.23
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP DNSP |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
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 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: 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 |
$74.97
|
| Rate for Payer: Priority Health Narrow Network |
$59.98
|
| 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: 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 |
$14,904.66
|
| Rate for Payer: Priority Health Narrow Network |
$11,924.41
|
| 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 |
$1,695.31 |
| Max. Negotiated Rate |
$8,109.00 |
| Rate for Payer: Aetna Commercial |
$7,298.10
|
| Rate for Payer: Aetna Medicare |
$3,162.90
|
| 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: ASR ASR |
$7,865.73
|
| Rate for Payer: ASR Commercial |
$7,865.73
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCBS Trust/PPO |
$6,640.46
|
| Rate for Payer: BCN Commercial |
$6,286.91
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| 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 |
$3,162.90
|
| Rate for Payer: Healthscope Commercial |
$8,109.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,865.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,162.90
|
| Rate for Payer: Mclaren Commercial |
$7,298.10
|
| 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 |
$6,892.65
|
| Rate for Payer: Nomi Health Commercial |
$6,649.38
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Commercial |
$3,479.19
|
| Rate for Payer: PHP Medicaid |
$1,695.31
|
| 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 |
$5,270.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,105.11
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Priority Health Narrow Network |
$5,684.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,135.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$4,902.49
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP DNSP |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
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 |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$218.36
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$235.34
|
| Rate for Payer: ASR Commercial |
$235.34
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$198.68
|
| Rate for Payer: BCN Commercial |
$188.10
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| 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 |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Healthscope Whirlpool |
$235.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$218.36
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.23
|
| Rate for Payer: Nomi Health Commercial |
$198.95
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| 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 |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$170.08
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$213.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
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
|
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 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 |
$103.87 |
| Max. Negotiated Rate |
$392.23 |
| Rate for Payer: Aetna Commercial |
$353.01
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$380.46
|
| Rate for Payer: ASR Commercial |
$380.46
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$321.20
|
| Rate for Payer: BCN Commercial |
$304.10
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| 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 |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$392.23
|
| Rate for Payer: Healthscope Whirlpool |
$380.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$353.01
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| 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 |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$274.95
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
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 2.1-3 CM
|
Facility
|
OP
|
$392.23
|
|
|
Service Code
|
CPT 17283
|
| Hospital Charge Code |
76100156
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$353.01
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$380.46
|
| Rate for Payer: ASR Commercial |
$380.46
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$321.20
|
| Rate for Payer: BCN Commercial |
$304.10
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| 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 |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$392.23
|
| Rate for Payer: Healthscope Whirlpool |
$380.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$353.01
|
| 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 |
$333.40
|
| Rate for Payer: Nomi Health Commercial |
$321.63
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| 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 |
$254.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.67
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$274.95
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$345.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
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 |
$319.99 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$542.15
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$584.32
|
| Rate for Payer: ASR Commercial |
$584.32
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$493.30
|
| Rate for Payer: BCN Commercial |
$467.03
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| 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 |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$602.39
|
| Rate for Payer: Healthscope Whirlpool |
$584.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$542.15
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: Nomi Health Commercial |
$493.96
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| 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 |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$422.28
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$530.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
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
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM >4 CM
|
Facility
|
OP
|
$602.39
|
|
|
Service Code
|
CPT 17286
|
| Hospital Charge Code |
76100158
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.99 |
| Max. Negotiated Rate |
$925.35 |
| Rate for Payer: Aetna Commercial |
$542.15
|
| Rate for Payer: Aetna Medicare |
$597.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: ASR ASR |
$584.32
|
| Rate for Payer: ASR Commercial |
$584.32
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCBS Trust/PPO |
$493.30
|
| Rate for Payer: BCN Commercial |
$467.03
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| 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 |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$602.39
|
| Rate for Payer: Healthscope Whirlpool |
$584.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$597.00
|
| Rate for Payer: Mclaren Commercial |
$542.15
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.03
|
| Rate for Payer: Nomi Health Commercial |
$493.96
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$656.70
|
| Rate for Payer: PHP Medicaid |
$319.99
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| 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 |
$597.00
|
| Rate for Payer: Priority Health Narrow Network |
$422.28
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$530.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Exchange |
$925.35
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP DNSP |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$319.99
|
| Rate for Payer: VA VA |
$597.00
|
|
|
HC DESTR MALIG LESION FACE,EAR,EYELID,NOSE,LIP,MUC MEM >4 CM
|
Facility
|
IP
|
$602.39
|
|
|
Service Code
|
CPT 17286
|
| Hospital Charge Code |
76100158
|
|
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
|
|
|
HC DESTR PENIS LESION, SIMPLE, CRYO
|
Facility
|
IP
|
$176.87
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.97 |
| Max. Negotiated Rate |
$176.87 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: ASR ASR |
$171.56
|
| Rate for Payer: ASR Commercial |
$171.56
|
| Rate for Payer: BCBS Trust/PPO |
$144.13
|
| Rate for Payer: BCN Commercial |
$137.13
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cofinity Commercial |
$166.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.50
|
| Rate for Payer: Healthscope Commercial |
$176.87
|
| Rate for Payer: Healthscope Whirlpool |
$171.56
|
| Rate for Payer: Mclaren Commercial |
$159.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: Nomi Health Commercial |
$145.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.65
|
|
|
HC DESTR PENIS LESION, SIMPLE, CRYO
|
Facility
|
OP
|
$176.87
|
|
|
Service Code
|
CPT 54056
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$171.56
|
| Rate for Payer: ASR Commercial |
$171.56
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$144.84
|
| Rate for Payer: BCN Commercial |
$137.13
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cash Price |
$141.50
|
| Rate for Payer: Cofinity Commercial |
$166.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$176.87
|
| Rate for Payer: Healthscope Whirlpool |
$171.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$159.18
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.34
|
| Rate for Payer: Nomi Health Commercial |
$145.03
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.97
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$123.99
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC DESTRUCT ANAL LESN(S) SIMPLE CHEM
|
Facility
|
OP
|
$490.03
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$475.33
|
| Rate for Payer: ASR Commercial |
$475.33
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$401.29
|
| Rate for Payer: BCN Commercial |
$379.92
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$460.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$490.03
|
| Rate for Payer: Healthscope Whirlpool |
$475.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$441.03
|
| 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 |
$416.53
|
| Rate for Payer: Nomi Health Commercial |
$401.82
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| 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 |
$318.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.36
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$343.51
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HC DESTRUCT ANAL LESN(S) SIMPLE CHEM
|
Facility
|
IP
|
$490.03
|
|
|
Service Code
|
CPT 46900
|
| Hospital Charge Code |
76100219
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.52 |
| Max. Negotiated Rate |
$490.03 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: ASR ASR |
$475.33
|
| Rate for Payer: ASR Commercial |
$475.33
|
| Rate for Payer: BCBS Trust/PPO |
$399.33
|
| Rate for Payer: BCN Commercial |
$379.92
|
| Rate for Payer: Cash Price |
$392.02
|
| Rate for Payer: Cofinity Commercial |
$460.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.02
|
| Rate for Payer: Healthscope Commercial |
$490.03
|
| Rate for Payer: Healthscope Whirlpool |
$475.33
|
| Rate for Payer: Mclaren Commercial |
$441.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.53
|
| Rate for Payer: Nomi Health Commercial |
$401.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$431.23
|
|
|
HC DESTRUCT BENIGN LESIONS 15 OR MORE
|
Facility
|
IP
|
$161.82
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.18 |
| Max. Negotiated Rate |
$161.82 |
| Rate for Payer: Aetna Commercial |
$145.64
|
| Rate for Payer: ASR ASR |
$156.97
|
| Rate for Payer: ASR Commercial |
$156.97
|
| Rate for Payer: BCBS Trust/PPO |
$131.87
|
| Rate for Payer: BCN Commercial |
$125.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$152.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Healthscope Commercial |
$161.82
|
| Rate for Payer: Healthscope Whirlpool |
$156.97
|
| Rate for Payer: Mclaren Commercial |
$145.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: Nomi Health Commercial |
$132.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.40
|
|
|
HC DESTRUCT BENIGN LESIONS 15 OR MORE
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
76100124
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$145.64
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$156.97
|
| Rate for Payer: ASR Commercial |
$156.97
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$132.51
|
| Rate for Payer: BCN Commercial |
$125.46
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cash Price |
$129.46
|
| Rate for Payer: Cofinity Commercial |
$152.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$161.82
|
| Rate for Payer: Healthscope Whirlpool |
$156.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$145.64
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.55
|
| Rate for Payer: Nomi Health Commercial |
$132.69
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.79
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$113.44
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC DESTRUCT BENIGN LESIONS UP TO 14 LESIONS
|
Facility
|
OP
|
$176.53
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$158.88
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$171.23
|
| Rate for Payer: ASR Commercial |
$171.23
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$144.56
|
| Rate for Payer: BCN Commercial |
$136.86
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cofinity Commercial |
$165.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$176.53
|
| Rate for Payer: Healthscope Whirlpool |
$171.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$158.88
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.05
|
| Rate for Payer: Nomi Health Commercial |
$144.75
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.68
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$123.75
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC DESTRUCT BENIGN LESIONS UP TO 14 LESIONS
|
Facility
|
IP
|
$176.53
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
76100123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.74 |
| Max. Negotiated Rate |
$176.53 |
| Rate for Payer: Aetna Commercial |
$158.88
|
| Rate for Payer: ASR ASR |
$171.23
|
| Rate for Payer: ASR Commercial |
$171.23
|
| Rate for Payer: BCBS Trust/PPO |
$143.85
|
| Rate for Payer: BCN Commercial |
$136.86
|
| Rate for Payer: Cash Price |
$141.22
|
| Rate for Payer: Cofinity Commercial |
$165.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.22
|
| Rate for Payer: Healthscope Commercial |
$176.53
|
| Rate for Payer: Healthscope Whirlpool |
$171.23
|
| Rate for Payer: Mclaren Commercial |
$158.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.05
|
| Rate for Payer: Nomi Health Commercial |
$144.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.35
|
|
