|
HC DESTRUCT MALIGNANT LESION TRUNK, ARMS, LEGS 1.1 TO 2.0 CM
|
Facility
|
OP
|
$161.82
|
|
|
Service Code
|
CPT 17262
|
| Hospital Charge Code |
76100127
|
|
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 MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
OP
|
$532.44
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$532.44 |
| Rate for Payer: Aetna Commercial |
$479.20
|
| 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 |
$516.47
|
| Rate for Payer: ASR Commercial |
$516.47
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$436.02
|
| Rate for Payer: BCN Commercial |
$412.80
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$425.95
|
| Rate for Payer: Cash Price |
$425.95
|
| Rate for Payer: Cofinity Commercial |
$500.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$532.44
|
| Rate for Payer: Healthscope Whirlpool |
$516.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$479.20
|
| 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 |
$452.57
|
| Rate for Payer: Nomi Health Commercial |
$436.60
|
| 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 |
$346.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$466.52
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$373.24
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$468.55
|
| 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 MALIGNANT LESION TRUNK, ARMS, LEGS 2.1 TO 3.0 CM
|
Facility
|
IP
|
$532.44
|
|
|
Service Code
|
CPT 17263
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.09 |
| Max. Negotiated Rate |
$532.44 |
| Rate for Payer: Aetna Commercial |
$479.20
|
| Rate for Payer: ASR ASR |
$516.47
|
| Rate for Payer: ASR Commercial |
$516.47
|
| Rate for Payer: BCBS Trust/PPO |
$433.89
|
| Rate for Payer: BCN Commercial |
$412.80
|
| Rate for Payer: Cash Price |
$425.95
|
| Rate for Payer: Cofinity Commercial |
$500.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.95
|
| Rate for Payer: Healthscope Commercial |
$532.44
|
| Rate for Payer: Healthscope Whirlpool |
$516.47
|
| Rate for Payer: Mclaren Commercial |
$479.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.57
|
| Rate for Payer: Nomi Health Commercial |
$436.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$468.55
|
|
|
HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV
|
Facility
|
IP
|
$408.88
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
36100608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$265.77 |
| Max. Negotiated Rate |
$408.88 |
| Rate for Payer: Aetna Commercial |
$367.99
|
| Rate for Payer: ASR ASR |
$396.61
|
| Rate for Payer: ASR Commercial |
$396.61
|
| Rate for Payer: BCBS Trust/PPO |
$333.20
|
| Rate for Payer: BCN Commercial |
$317.00
|
| Rate for Payer: Cash Price |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$384.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.10
|
| Rate for Payer: Healthscope Commercial |
$408.88
|
| Rate for Payer: Healthscope Whirlpool |
$396.61
|
| Rate for Payer: Mclaren Commercial |
$367.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.55
|
| Rate for Payer: Nomi Health Commercial |
$335.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.81
|
|
|
HC DESTRUCT NEURO AGENT PLANTAR DIGITAL NRV
|
Facility
|
OP
|
$408.88
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
36100608
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$446.23 |
| Rate for Payer: Aetna Commercial |
$367.99
|
| 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 |
$396.61
|
| Rate for Payer: ASR Commercial |
$396.61
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCBS Trust/PPO |
$334.83
|
| Rate for Payer: BCN Commercial |
$317.00
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$327.10
|
| Rate for Payer: Cash Price |
$327.10
|
| Rate for Payer: Cofinity Commercial |
$384.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$408.88
|
| Rate for Payer: Healthscope Whirlpool |
$396.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$287.89
|
| Rate for Payer: Mclaren Commercial |
$367.99
|
| 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 |
$347.55
|
| Rate for Payer: Nomi Health Commercial |
$335.28
|
| 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 |
$265.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.26
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health Narrow Network |
$286.62
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.81
|
| 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 DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$281.59 |
| Rate for Payer: Aetna Commercial |
$253.43
|
| Rate for Payer: ASR ASR |
$273.14
|
| Rate for Payer: ASR Commercial |
$273.14
|
| Rate for Payer: BCBS Trust/PPO |
$229.47
|
| Rate for Payer: BCN Commercial |
$218.32
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$264.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$281.59
|
| Rate for Payer: Healthscope Whirlpool |
$273.14
|
| Rate for Payer: Mclaren Commercial |
$253.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.80
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS 15 OR MORE LESIONS
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
76100122
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$603.96 |
| Rate for Payer: Aetna Commercial |
$253.43
|
| 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 |
$273.14
|
| Rate for Payer: ASR Commercial |
$273.14
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$230.59
|
| Rate for Payer: BCN Commercial |
$218.32
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$264.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$281.59
|
| Rate for Payer: Healthscope Whirlpool |
$273.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$253.43
|
| 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 |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| 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 |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$246.73
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$197.39
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.80
|
| 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 PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
OP
|
$176.53
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
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 PREMALIGNANT LESIONS FIRST LESION
|
Facility
|
IP
|
$176.53
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
76100120
|
|
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
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
OP
|
$35.48
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: Aetna Medicare |
$17.74
|
| Rate for Payer: ASR ASR |
$34.42
|
| Rate for Payer: ASR Commercial |
$34.42
|
| Rate for Payer: BCBS Complete |
$14.19
|
| Rate for Payer: BCBS Trust/PPO |
$29.05
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: Cash Price |
$28.38
|
| Rate for Payer: Cofinity Commercial |
$33.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.38
|
| Rate for Payer: Healthscope Commercial |
$35.48
|
| Rate for Payer: Healthscope Whirlpool |
$34.42
|
| Rate for Payer: Mclaren Commercial |
$31.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.16
|
| Rate for Payer: Nomi Health Commercial |
$29.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.09
|
| Rate for Payer: Priority Health Narrow Network |
$24.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.22
|
|
|
HC DESTRUCT PREMALIGNANT LESIONS SECOND THRU 14 LESIONS EACH
|
Facility
|
IP
|
$35.48
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
76100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$35.48 |
| Rate for Payer: Aetna Commercial |
$31.93
|
| Rate for Payer: ASR ASR |
$34.42
|
| Rate for Payer: ASR Commercial |
$34.42
|
| Rate for Payer: BCBS Trust/PPO |
$28.91
|
| Rate for Payer: BCN Commercial |
$27.51
|
| Rate for Payer: Cash Price |
$28.38
|
| Rate for Payer: Cofinity Commercial |
$33.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.38
|
| Rate for Payer: Healthscope Commercial |
$35.48
|
| Rate for Payer: Healthscope Whirlpool |
$34.42
|
| Rate for Payer: Mclaren Commercial |
$31.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.16
|
| Rate for Payer: Nomi Health Commercial |
$29.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.22
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
OP
|
$3,898.53
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$4,806.44 |
| Rate for Payer: Aetna Commercial |
$3,508.68
|
| Rate for Payer: Aetna Medicare |
$3,100.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: ASR ASR |
$3,781.57
|
| Rate for Payer: ASR Commercial |
$3,781.57
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$3,192.51
|
| Rate for Payer: BCN Commercial |
$3,022.53
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$3,118.82
|
| Rate for Payer: Cash Price |
$3,118.82
|
| Rate for Payer: Cofinity Commercial |
$3,664.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,118.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$3,898.53
|
| Rate for Payer: Healthscope Whirlpool |
$3,781.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$3,508.68
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,313.75
|
| Rate for Payer: Nomi Health Commercial |
$3,196.79
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$3,411.02
|
| Rate for Payer: PHP Medicaid |
$1,662.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,534.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,415.89
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,732.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,430.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$4,806.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP DNSP |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
HC DESTRUCT VAGINAL LESION(S) SIMPLE
|
Facility
|
IP
|
$3,898.53
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
36100583
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,534.04 |
| Max. Negotiated Rate |
$3,898.53 |
| Rate for Payer: Aetna Commercial |
$3,508.68
|
| Rate for Payer: ASR ASR |
$3,781.57
|
| Rate for Payer: ASR Commercial |
$3,781.57
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.91
|
| Rate for Payer: BCN Commercial |
$3,022.53
|
| Rate for Payer: Cash Price |
$3,118.82
|
| Rate for Payer: Cofinity Commercial |
$3,664.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,118.82
|
| Rate for Payer: Healthscope Commercial |
$3,898.53
|
| Rate for Payer: Healthscope Whirlpool |
$3,781.57
|
| Rate for Payer: Mclaren Commercial |
$3,508.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,313.75
|
| Rate for Payer: Nomi Health Commercial |
$3,196.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,534.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,430.71
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
IP
|
$24,667.58
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$16,033.93 |
| Max. Negotiated Rate |
$24,667.58 |
| Rate for Payer: Aetna Commercial |
$22,200.82
|
| Rate for Payer: ASR ASR |
$23,927.55
|
| Rate for Payer: ASR Commercial |
$23,927.55
|
| Rate for Payer: BCBS Trust/PPO |
$20,101.61
|
| Rate for Payer: BCN Commercial |
$19,124.77
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$23,187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Healthscope Commercial |
$24,667.58
|
| Rate for Payer: Healthscope Whirlpool |
$23,927.55
|
| Rate for Payer: Mclaren Commercial |
$22,200.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,967.44
|
| Rate for Payer: Nomi Health Commercial |
$20,227.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,033.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,707.47
|
|
|
HC DES VESSEL/BRANCH
|
Facility
|
OP
|
$24,667.58
|
|
|
Service Code
|
CPT C9600
|
| Hospital Charge Code |
48100075
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$24,667.58 |
| Rate for Payer: Aetna Commercial |
$22,200.82
|
| Rate for Payer: Aetna Medicare |
$11,060.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: ASR ASR |
$23,927.55
|
| Rate for Payer: ASR Commercial |
$23,927.55
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCBS Trust/PPO |
$20,200.28
|
| Rate for Payer: BCN Commercial |
$19,124.77
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cash Price |
$19,734.06
|
| Rate for Payer: Cofinity Commercial |
$23,187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,734.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Healthscope Commercial |
$24,667.58
|
| Rate for Payer: Healthscope Whirlpool |
$23,927.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,060.23
|
| Rate for Payer: Mclaren Commercial |
$22,200.82
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,967.44
|
| Rate for Payer: Nomi Health Commercial |
$20,227.42
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Commercial |
$12,166.25
|
| Rate for Payer: PHP Medicaid |
$5,928.28
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,033.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,613.73
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Priority Health Narrow Network |
$17,291.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,707.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$17,143.36
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP DNSP |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
OP
|
$379.19
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.68 |
| Max. Negotiated Rate |
$379.19 |
| Rate for Payer: Aetna Commercial |
$341.27
|
| Rate for Payer: Aetna Medicare |
$189.59
|
| Rate for Payer: ASR ASR |
$367.81
|
| Rate for Payer: ASR Commercial |
$367.81
|
| Rate for Payer: BCBS Complete |
$151.68
|
| Rate for Payer: BCBS Trust/PPO |
$310.52
|
| Rate for Payer: BCN Commercial |
$293.99
|
| Rate for Payer: Cash Price |
$303.35
|
| Rate for Payer: Cofinity Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.35
|
| Rate for Payer: Healthscope Commercial |
$379.19
|
| Rate for Payer: Healthscope Whirlpool |
$367.81
|
| Rate for Payer: Mclaren Commercial |
$341.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.31
|
| Rate for Payer: Nomi Health Commercial |
$310.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$332.25
|
| Rate for Payer: Priority Health Narrow Network |
$265.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.69
|
|
|
HC DEVELOPMENTAL TESTING
|
Facility
|
IP
|
$379.19
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
51000057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$379.19 |
| Rate for Payer: Aetna Commercial |
$341.27
|
| Rate for Payer: ASR ASR |
$367.81
|
| Rate for Payer: ASR Commercial |
$367.81
|
| Rate for Payer: BCBS Trust/PPO |
$309.00
|
| Rate for Payer: BCN Commercial |
$293.99
|
| Rate for Payer: Cash Price |
$303.35
|
| Rate for Payer: Cofinity Commercial |
$356.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.35
|
| Rate for Payer: Healthscope Commercial |
$379.19
|
| Rate for Payer: Healthscope Whirlpool |
$367.81
|
| Rate for Payer: Mclaren Commercial |
$341.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.31
|
| Rate for Payer: Nomi Health Commercial |
$310.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$333.69
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
HCPCS 00615
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$387.20 |
| Max. Negotiated Rate |
$629.20 |
| Rate for Payer: Aetna Medicare |
$484.00
|
| Rate for Payer: BCBS Complete |
$387.20
|
| Rate for Payer: Cash Price |
$774.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.20
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
HCPCS 00615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$387.20 |
| Max. Negotiated Rate |
$629.20 |
| Rate for Payer: Aetna Medicare |
$484.00
|
| Rate for Payer: BCBS Complete |
$387.20
|
| Rate for Payer: Cash Price |
$774.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.20
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
IP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$616.85 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$854.10
|
| Rate for Payer: ASR ASR |
$920.53
|
| Rate for Payer: ASR Commercial |
$920.53
|
| Rate for Payer: BCBS Trust/PPO |
$773.34
|
| Rate for Payer: BCN Commercial |
$735.76
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$892.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Healthscope Commercial |
$949.00
|
| Rate for Payer: Healthscope Whirlpool |
$920.53
|
| Rate for Payer: Mclaren Commercial |
$854.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.65
|
| Rate for Payer: Nomi Health Commercial |
$778.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$835.12
|
|
|
HC DEVICE NOT RETURNED ACTIWATCH
|
Facility
|
OP
|
$949.00
|
|
| Hospital Charge Code |
27000615
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$379.60 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$854.10
|
| Rate for Payer: Aetna Medicare |
$474.50
|
| Rate for Payer: ASR ASR |
$920.53
|
| Rate for Payer: ASR Commercial |
$920.53
|
| Rate for Payer: BCBS Complete |
$379.60
|
| Rate for Payer: BCBS Trust/PPO |
$777.14
|
| Rate for Payer: BCN Commercial |
$735.76
|
| Rate for Payer: Cash Price |
$759.20
|
| Rate for Payer: Cofinity Commercial |
$892.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.20
|
| Rate for Payer: Healthscope Commercial |
$949.00
|
| Rate for Payer: Healthscope Whirlpool |
$920.53
|
| Rate for Payer: Mclaren Commercial |
$854.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$806.65
|
| Rate for Payer: Nomi Health Commercial |
$778.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$831.51
|
| Rate for Payer: Priority Health Narrow Network |
$665.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$835.12
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 00616
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
IP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: ASR ASR |
$300.70
|
| Rate for Payer: ASR Commercial |
$300.70
|
| Rate for Payer: BCBS Trust/PPO |
$252.62
|
| Rate for Payer: BCN Commercial |
$240.34
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$291.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Healthscope Commercial |
$310.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.70
|
| Rate for Payer: Mclaren Commercial |
$279.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.80
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 00616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
|
|
HC DEVICE NOT RETURNED AIR 10 OXIMETRY
|
Facility
|
OP
|
$310.00
|
|
| Hospital Charge Code |
27000616
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: ASR ASR |
$300.70
|
| Rate for Payer: ASR Commercial |
$300.70
|
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$253.86
|
| Rate for Payer: BCN Commercial |
$240.34
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$291.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Healthscope Commercial |
$310.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.70
|
| Rate for Payer: Mclaren Commercial |
$279.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$271.62
|
| Rate for Payer: Priority Health Narrow Network |
$217.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.80
|
|
