|
HC EXCISION VAGINAL CYST/TUMOR
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
76100333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| 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 |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCBS Trust/PPO |
$6,506.59
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,100.93
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| 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 |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| 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 |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,961.87
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health Narrow Network |
$5,569.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
| 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 EXCISION VAGINAL CYST/TUMOR
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
76100333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,164.59 |
| Max. Negotiated Rate |
$7,945.53 |
| Rate for Payer: Aetna Commercial |
$7,150.98
|
| Rate for Payer: ASR ASR |
$7,707.16
|
| Rate for Payer: ASR Commercial |
$7,707.16
|
| Rate for Payer: BCBS Trust/PPO |
$6,474.81
|
| Rate for Payer: BCN Commercial |
$6,160.17
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$7,468.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,945.53
|
| Rate for Payer: Healthscope Whirlpool |
$7,707.16
|
| Rate for Payer: Mclaren Commercial |
$7,150.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,992.07
|
|
|
HC EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
IP
|
$2,927.69
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
76100309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,903.00 |
| Max. Negotiated Rate |
$2,927.69 |
| Rate for Payer: Aetna Commercial |
$2,634.92
|
| Rate for Payer: ASR ASR |
$2,839.86
|
| Rate for Payer: ASR Commercial |
$2,839.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,385.77
|
| Rate for Payer: BCN Commercial |
$2,269.84
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cofinity Commercial |
$2,752.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,342.15
|
| Rate for Payer: Healthscope Commercial |
$2,927.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,839.86
|
| Rate for Payer: Mclaren Commercial |
$2,634.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,488.54
|
| Rate for Payer: Nomi Health Commercial |
$2,400.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,576.37
|
|
|
HC EXC LEG/ANKLE TUM < 3 CM
|
Facility
|
OP
|
$2,927.69
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
76100309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,927.69 |
| Rate for Payer: Aetna Commercial |
$2,634.92
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,839.86
|
| Rate for Payer: ASR Commercial |
$2,839.86
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,397.49
|
| Rate for Payer: BCN Commercial |
$2,269.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cash Price |
$2,342.15
|
| Rate for Payer: Cofinity Commercial |
$2,752.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,342.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,927.69
|
| Rate for Payer: Healthscope Whirlpool |
$2,839.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$2,634.92
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,488.54
|
| Rate for Payer: Nomi Health Commercial |
$2,400.71
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,903.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,565.24
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,052.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,576.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC EXC LESION MUCOSA SBMCSL VESTIBULE SMPL RPR
|
Facility
|
OP
|
$4,268.00
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
76100430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.34 |
| Max. Negotiated Rate |
$4,268.00 |
| Rate for Payer: Aetna Commercial |
$3,841.20
|
| Rate for Payer: Aetna Medicare |
$1,444.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,805.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,805.83
|
| Rate for Payer: ASR ASR |
$4,139.96
|
| Rate for Payer: ASR Commercial |
$4,139.96
|
| Rate for Payer: BCBS Complete |
$813.05
|
| Rate for Payer: BCBS MAPPO |
$1,444.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,495.07
|
| Rate for Payer: BCN Commercial |
$3,308.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.66
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cofinity Commercial |
$4,011.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.66
|
| Rate for Payer: Healthscope Commercial |
$4,268.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,139.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,444.66
|
| Rate for Payer: Mclaren Commercial |
$3,841.20
|
| Rate for Payer: Mclaren Medicaid |
$774.34
|
| Rate for Payer: Mclaren Medicare |
$1,444.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.89
|
| Rate for Payer: Meridian Medicaid |
$813.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,661.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,627.80
|
| Rate for Payer: Nomi Health Commercial |
$3,499.76
|
| Rate for Payer: PACE Medicare |
$1,372.43
|
| Rate for Payer: PACE SWMI |
$1,444.66
|
| Rate for Payer: PHP Commercial |
$1,589.13
|
| Rate for Payer: PHP Medicaid |
$774.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,774.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,739.62
|
| Rate for Payer: Priority Health Medicare |
$1,444.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,991.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,755.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,444.66
|
| Rate for Payer: UHC Exchange |
$2,239.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,444.66
|
| Rate for Payer: UHCCP DNSP |
$1,444.66
|
| Rate for Payer: UHCCP Medicaid |
$774.34
|
| Rate for Payer: VA VA |
$1,444.66
|
|
|
HC EXC LESION MUCOSA SBMCSL VESTIBULE SMPL RPR
|
Facility
|
IP
|
$4,268.00
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
76100430
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,774.20 |
| Max. Negotiated Rate |
$4,268.00 |
| Rate for Payer: Aetna Commercial |
$3,841.20
|
| Rate for Payer: ASR ASR |
$4,139.96
|
| Rate for Payer: ASR Commercial |
$4,139.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,477.99
|
| Rate for Payer: BCN Commercial |
$3,308.98
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cofinity Commercial |
$4,011.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,414.40
|
| Rate for Payer: Healthscope Commercial |
$4,268.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,139.96
|
| Rate for Payer: Mclaren Commercial |
$3,841.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,627.80
|
| Rate for Payer: Nomi Health Commercial |
$3,499.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,774.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,755.84
|
|
|
HC EXC LESION PALATE UVULA W/O CLOSURE
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 42104
|
| Hospital Charge Code |
76100467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,237.70 |
| Max. Negotiated Rate |
$8,058.00 |
| Rate for Payer: Aetna Commercial |
$7,252.20
|
| Rate for Payer: ASR ASR |
$7,816.26
|
| Rate for Payer: ASR Commercial |
$7,816.26
|
| Rate for Payer: BCBS Trust/PPO |
$6,566.46
|
| Rate for Payer: BCN Commercial |
$6,247.37
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$7,574.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$8,058.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,816.26
|
| Rate for Payer: Mclaren Commercial |
$7,252.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,091.04
|
|
|
HC EXC LESION PALATE UVULA W/O CLOSURE
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 42104
|
| Hospital Charge Code |
76100467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,058.00 |
| Rate for Payer: Aetna Commercial |
$7,252.20
|
| 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 |
$7,816.26
|
| Rate for Payer: ASR Commercial |
$7,816.26
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCBS Trust/PPO |
$6,598.70
|
| Rate for Payer: BCN Commercial |
$6,247.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$7,574.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Healthscope Commercial |
$8,058.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,816.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,162.90
|
| Rate for Payer: Mclaren Commercial |
$7,252.20
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| 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 |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,060.42
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Priority Health Narrow Network |
$5,648.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,091.04
|
| 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 EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 40510
|
| Hospital Charge Code |
76100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,058.00 |
| Rate for Payer: Aetna Commercial |
$7,252.20
|
| 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 |
$7,816.26
|
| Rate for Payer: ASR Commercial |
$7,816.26
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCBS Trust/PPO |
$6,598.70
|
| Rate for Payer: BCN Commercial |
$6,247.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$7,574.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Healthscope Commercial |
$8,058.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,816.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,162.90
|
| Rate for Payer: Mclaren Commercial |
$7,252.20
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| 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 |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,060.42
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Priority Health Narrow Network |
$5,648.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,091.04
|
| 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 EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 40510
|
| Hospital Charge Code |
76100457
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,237.70 |
| Max. Negotiated Rate |
$8,058.00 |
| Rate for Payer: Aetna Commercial |
$7,252.20
|
| Rate for Payer: ASR ASR |
$7,816.26
|
| Rate for Payer: ASR Commercial |
$7,816.26
|
| Rate for Payer: BCBS Trust/PPO |
$6,566.46
|
| Rate for Payer: BCN Commercial |
$6,247.37
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$7,574.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$8,058.00
|
| Rate for Payer: Healthscope Whirlpool |
$7,816.26
|
| Rate for Payer: Mclaren Commercial |
$7,252.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,091.04
|
|
|
HC EXC MALIGNANT LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.5 CM OR LESS
|
Facility
|
IP
|
$1,176.05
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
76100107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.43 |
| Max. Negotiated Rate |
$1,176.05 |
| Rate for Payer: Aetna Commercial |
$1,058.44
|
| Rate for Payer: ASR ASR |
$1,140.77
|
| Rate for Payer: ASR Commercial |
$1,140.77
|
| Rate for Payer: BCBS Trust/PPO |
$958.36
|
| Rate for Payer: BCN Commercial |
$911.79
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Healthscope Commercial |
$1,176.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.77
|
| Rate for Payer: Mclaren Commercial |
$1,058.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: Nomi Health Commercial |
$964.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.92
|
|
|
HC EXC MALIGNANT LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.5 CM OR LESS
|
Facility
|
OP
|
$1,176.05
|
|
|
Service Code
|
CPT 11620
|
| Hospital Charge Code |
76100107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.43 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,058.44
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$1,140.77
|
| Rate for Payer: ASR Commercial |
$1,140.77
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$963.07
|
| Rate for Payer: BCN Commercial |
$911.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$1,176.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,058.44
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: Nomi Health Commercial |
$964.36
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,030.46
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$824.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC EXC MALIGNANT LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.5 TO 1.0 CM
|
Facility
|
OP
|
$1,176.05
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
76100108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,176.05 |
| Rate for Payer: Aetna Commercial |
$1,058.44
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$1,140.77
|
| Rate for Payer: ASR Commercial |
$1,140.77
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$963.07
|
| Rate for Payer: BCN Commercial |
$911.79
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,176.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$1,058.44
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: Nomi Health Commercial |
$964.36
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,030.46
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$824.41
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC EXC MALIGNANT LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.5 TO 1.0 CM
|
Facility
|
IP
|
$1,176.05
|
|
|
Service Code
|
CPT 11621
|
| Hospital Charge Code |
76100108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.43 |
| Max. Negotiated Rate |
$1,176.05 |
| Rate for Payer: Aetna Commercial |
$1,058.44
|
| Rate for Payer: ASR ASR |
$1,140.77
|
| Rate for Payer: ASR Commercial |
$1,140.77
|
| Rate for Payer: BCBS Trust/PPO |
$958.36
|
| Rate for Payer: BCN Commercial |
$911.79
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Healthscope Commercial |
$1,176.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.77
|
| Rate for Payer: Mclaren Commercial |
$1,058.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: Nomi Health Commercial |
$964.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.92
|
|
|
HC EXC MALIGNANT LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.0 TO 2.0 CM
|
Facility
|
OP
|
$1,176.05
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
76100109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,176.05 |
| Rate for Payer: Aetna Commercial |
$1,058.44
|
| Rate for Payer: Aetna Medicare |
$686.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: ASR ASR |
$1,140.77
|
| Rate for Payer: ASR Commercial |
$1,140.77
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCBS Trust/PPO |
$963.07
|
| Rate for Payer: BCN Commercial |
$911.79
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,176.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$686.20
|
| Rate for Payer: Mclaren Commercial |
$1,058.44
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: Nomi Health Commercial |
$964.36
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$754.82
|
| Rate for Payer: PHP Medicaid |
$367.80
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,030.46
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health Narrow Network |
$824.41
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP DNSP |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
HC EXC MALIGNANT LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.0 TO 2.0 CM
|
Facility
|
IP
|
$1,176.05
|
|
|
Service Code
|
CPT 11622
|
| Hospital Charge Code |
76100109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.43 |
| Max. Negotiated Rate |
$1,176.05 |
| Rate for Payer: Aetna Commercial |
$1,058.44
|
| Rate for Payer: ASR ASR |
$1,140.77
|
| Rate for Payer: ASR Commercial |
$1,140.77
|
| Rate for Payer: BCBS Trust/PPO |
$958.36
|
| Rate for Payer: BCN Commercial |
$911.79
|
| Rate for Payer: Cash Price |
$940.84
|
| Rate for Payer: Cofinity Commercial |
$1,105.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.84
|
| Rate for Payer: Healthscope Commercial |
$1,176.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.77
|
| Rate for Payer: Mclaren Commercial |
$1,058.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.64
|
| Rate for Payer: Nomi Health Commercial |
$964.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,034.92
|
|
|
HC EXC SINGLE EXTERNAL PAPILLA OR TAG, ANUS
|
Facility
|
IP
|
$1,567.19
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
76100280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,018.67 |
| Max. Negotiated Rate |
$1,567.19 |
| Rate for Payer: Aetna Commercial |
$1,410.47
|
| Rate for Payer: ASR ASR |
$1,520.17
|
| Rate for Payer: ASR Commercial |
$1,520.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,277.10
|
| Rate for Payer: BCN Commercial |
$1,215.04
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cofinity Commercial |
$1,473.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,253.75
|
| Rate for Payer: Healthscope Commercial |
$1,567.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,520.17
|
| Rate for Payer: Mclaren Commercial |
$1,410.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.11
|
| Rate for Payer: Nomi Health Commercial |
$1,285.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,018.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,379.13
|
|
|
HC EXC SINGLE EXTERNAL PAPILLA OR TAG, ANUS
|
Facility
|
OP
|
$1,567.19
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
76100280
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$1,782.39 |
| Rate for Payer: Aetna Commercial |
$1,410.47
|
| Rate for Payer: Aetna Medicare |
$1,149.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: ASR ASR |
$1,520.17
|
| Rate for Payer: ASR Commercial |
$1,520.17
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,283.37
|
| Rate for Payer: BCN Commercial |
$1,215.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cofinity Commercial |
$1,473.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,253.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$1,567.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,520.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,149.93
|
| Rate for Payer: Mclaren Commercial |
$1,410.47
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.11
|
| Rate for Payer: Nomi Health Commercial |
$1,285.10
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,264.92
|
| Rate for Payer: PHP Medicaid |
$616.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,018.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,373.17
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,098.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,379.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$1,782.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP DNSP |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
HC EXC SKIN MALIG 2.1-3CM FACE, FACIAL
|
Facility
|
OP
|
$2,146.61
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
76100215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,931.95
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,082.21
|
| Rate for Payer: ASR Commercial |
$2,082.21
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.86
|
| Rate for Payer: BCN Commercial |
$1,664.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cofinity Commercial |
$2,017.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,146.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,931.95
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.62
|
| Rate for Payer: Nomi Health Commercial |
$1,760.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.86
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,504.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,889.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC EXC SKIN MALIG 2.1-3CM FACE, FACIAL
|
Facility
|
IP
|
$2,146.61
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
76100215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.30 |
| Max. Negotiated Rate |
$2,146.61 |
| Rate for Payer: Aetna Commercial |
$1,931.95
|
| Rate for Payer: ASR ASR |
$2,082.21
|
| Rate for Payer: ASR Commercial |
$2,082.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.27
|
| Rate for Payer: BCN Commercial |
$1,664.27
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cofinity Commercial |
$2,017.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.29
|
| Rate for Payer: Healthscope Commercial |
$2,146.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.21
|
| Rate for Payer: Mclaren Commercial |
$1,931.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.62
|
| Rate for Payer: Nomi Health Commercial |
$1,760.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,889.02
|
|
|
HC EXC SKIN MALIG 2.1-3 CM REMAINDER BODY
|
Facility
|
IP
|
$2,146.61
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
76100212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.30 |
| Max. Negotiated Rate |
$2,146.61 |
| Rate for Payer: Aetna Commercial |
$1,931.95
|
| Rate for Payer: ASR ASR |
$2,082.21
|
| Rate for Payer: ASR Commercial |
$2,082.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.27
|
| Rate for Payer: BCN Commercial |
$1,664.27
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cofinity Commercial |
$2,017.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.29
|
| Rate for Payer: Healthscope Commercial |
$2,146.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.21
|
| Rate for Payer: Mclaren Commercial |
$1,931.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.62
|
| Rate for Payer: Nomi Health Commercial |
$1,760.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,889.02
|
|
|
HC EXC SKIN MALIG 2.1-3 CM REMAINDER BODY
|
Facility
|
OP
|
$2,146.61
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
76100212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,931.95
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,082.21
|
| Rate for Payer: ASR Commercial |
$2,082.21
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.86
|
| Rate for Payer: BCN Commercial |
$1,664.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cofinity Commercial |
$2,017.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,146.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,931.95
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.62
|
| Rate for Payer: Nomi Health Commercial |
$1,760.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.86
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,504.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,889.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC EXC SKIN MALIG 3.1-4CM FACE, FACIAL
|
Facility
|
OP
|
$2,146.61
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
76100216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$1,931.95
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$2,082.21
|
| Rate for Payer: ASR Commercial |
$2,082.21
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.86
|
| Rate for Payer: BCN Commercial |
$1,664.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cofinity Commercial |
$2,017.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$2,146.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$1,931.95
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.62
|
| Rate for Payer: Nomi Health Commercial |
$1,760.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.86
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,504.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,889.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
HC EXC SKIN MALIG 3.1-4CM FACE, FACIAL
|
Facility
|
IP
|
$2,146.61
|
|
|
Service Code
|
CPT 11644
|
| Hospital Charge Code |
76100216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.30 |
| Max. Negotiated Rate |
$2,146.61 |
| Rate for Payer: Aetna Commercial |
$1,931.95
|
| Rate for Payer: ASR ASR |
$2,082.21
|
| Rate for Payer: ASR Commercial |
$2,082.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.27
|
| Rate for Payer: BCN Commercial |
$1,664.27
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cofinity Commercial |
$2,017.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.29
|
| Rate for Payer: Healthscope Commercial |
$2,146.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.21
|
| Rate for Payer: Mclaren Commercial |
$1,931.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.62
|
| Rate for Payer: Nomi Health Commercial |
$1,760.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,889.02
|
|
|
HC EXC SKIN MALIG 3.1-4 CM REMAINDER BODY
|
Facility
|
IP
|
$2,146.61
|
|
|
Service Code
|
CPT 11624
|
| Hospital Charge Code |
76100213
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.30 |
| Max. Negotiated Rate |
$2,146.61 |
| Rate for Payer: Aetna Commercial |
$1,931.95
|
| Rate for Payer: ASR ASR |
$2,082.21
|
| Rate for Payer: ASR Commercial |
$2,082.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.27
|
| Rate for Payer: BCN Commercial |
$1,664.27
|
| Rate for Payer: Cash Price |
$1,717.29
|
| Rate for Payer: Cofinity Commercial |
$2,017.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,717.29
|
| Rate for Payer: Healthscope Commercial |
$2,146.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,082.21
|
| Rate for Payer: Mclaren Commercial |
$1,931.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,824.62
|
| Rate for Payer: Nomi Health Commercial |
$1,760.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,395.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,889.02
|
|
