|
HC INSULIN ANTIBODIES
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$69.36 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Trust/PPO |
$56.52
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
|
|
HC INSULIN ANTIBODIES
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 86337
|
| Hospital Charge Code |
30200199
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$233.88 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.76
|
| Rate for Payer: ASR ASR |
$67.28
|
| Rate for Payer: ASR Commercial |
$67.28
|
| Rate for Payer: BCBS Complete |
$12.05
|
| Rate for Payer: BCBS MAPPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$56.80
|
| Rate for Payer: BCN Commercial |
$53.77
|
| Rate for Payer: BCN Medicare Advantage |
$21.41
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$65.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$69.36
|
| Rate for Payer: Healthscope Whirlpool |
$67.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.41
|
| Rate for Payer: Mclaren Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.48
|
| Rate for Payer: Meridian Medicaid |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: PACE Medicare |
$20.34
|
| Rate for Payer: PACE SWMI |
$21.41
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.88
|
| Rate for Payer: Priority Health Medicare |
$21.41
|
| Rate for Payer: Priority Health Narrow Network |
$187.10
|
| Rate for Payer: Railroad Medicare Medicare |
$21.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.41
|
| Rate for Payer: UHC Exchange |
$33.19
|
| Rate for Payer: UHC Medicare Advantage |
$21.41
|
| Rate for Payer: UHCCP DNSP |
$21.41
|
| Rate for Payer: UHCCP Medicaid |
$11.48
|
| Rate for Payer: VA VA |
$21.41
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$40.90
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$250.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INSULIN LIKE GROWTH FACTOR BP3
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100258
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: ASR ASR |
$48.44
|
| Rate for Payer: ASR Commercial |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$40.70
|
| Rate for Payer: BCN Commercial |
$38.72
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$46.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Healthscope Whirlpool |
$48.44
|
| Rate for Payer: Mclaren Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.95
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
OP
|
$189.78
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$75.91 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna Medicare |
$94.89
|
| Rate for Payer: ASR ASR |
$184.09
|
| Rate for Payer: ASR Commercial |
$184.09
|
| Rate for Payer: BCBS Complete |
$75.91
|
| Rate for Payer: BCBS Trust/PPO |
$155.41
|
| Rate for Payer: BCN Commercial |
$147.14
|
| Rate for Payer: Cash Price |
$151.82
|
| Rate for Payer: Cofinity Commercial |
$178.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$189.78
|
| Rate for Payer: Healthscope Whirlpool |
$184.09
|
| Rate for Payer: Mclaren Commercial |
$170.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.31
|
| Rate for Payer: Nomi Health Commercial |
$155.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.29
|
| Rate for Payer: Priority Health Narrow Network |
$133.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.01
|
|
|
HC INTENSIVE CARE OBS OVERFLOW PER HR
|
Facility
|
IP
|
$189.78
|
|
| Hospital Charge Code |
76900004
|
|
Hospital Revenue Code
|
769
|
| Min. Negotiated Rate |
$123.36 |
| Max. Negotiated Rate |
$189.78 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: ASR ASR |
$184.09
|
| Rate for Payer: ASR Commercial |
$184.09
|
| Rate for Payer: BCBS Trust/PPO |
$154.65
|
| Rate for Payer: BCN Commercial |
$147.14
|
| Rate for Payer: Cash Price |
$151.82
|
| Rate for Payer: Cofinity Commercial |
$178.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.82
|
| Rate for Payer: Healthscope Commercial |
$189.78
|
| Rate for Payer: Healthscope Whirlpool |
$184.09
|
| Rate for Payer: Mclaren Commercial |
$170.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.31
|
| Rate for Payer: Nomi Health Commercial |
$155.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.01
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
OP
|
$1,185.64
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.26 |
| Max. Negotiated Rate |
$1,185.64 |
| Rate for Payer: Aetna Commercial |
$1,067.08
|
| Rate for Payer: Aetna Medicare |
$592.82
|
| Rate for Payer: ASR ASR |
$1,150.07
|
| Rate for Payer: ASR Commercial |
$1,150.07
|
| Rate for Payer: BCBS Complete |
$474.26
|
| Rate for Payer: BCBS Trust/PPO |
$970.92
|
| Rate for Payer: BCN Commercial |
$919.23
|
| Rate for Payer: Cash Price |
$948.51
|
| Rate for Payer: Cofinity Commercial |
$1,114.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,185.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,150.07
|
| Rate for Payer: Mclaren Commercial |
$1,067.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.79
|
| Rate for Payer: Nomi Health Commercial |
$972.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,038.86
|
| Rate for Payer: Priority Health Narrow Network |
$831.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,043.36
|
|
|
HC INTERCEDE ANTIADHESIVE
|
Facility
|
IP
|
$1,185.64
|
|
| Hospital Charge Code |
27200134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$770.67 |
| Max. Negotiated Rate |
$1,185.64 |
| Rate for Payer: Aetna Commercial |
$1,067.08
|
| Rate for Payer: ASR ASR |
$1,150.07
|
| Rate for Payer: ASR Commercial |
$1,150.07
|
| Rate for Payer: BCBS Trust/PPO |
$966.18
|
| Rate for Payer: BCN Commercial |
$919.23
|
| Rate for Payer: Cash Price |
$948.51
|
| Rate for Payer: Cofinity Commercial |
$1,114.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,185.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,150.07
|
| Rate for Payer: Mclaren Commercial |
$1,067.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.79
|
| Rate for Payer: Nomi Health Commercial |
$972.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,043.36
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
IP
|
$131.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$85.53 |
| Max. Negotiated Rate |
$131.58 |
| Rate for Payer: Aetna Commercial |
$118.42
|
| Rate for Payer: ASR ASR |
$127.63
|
| Rate for Payer: ASR Commercial |
$127.63
|
| Rate for Payer: BCBS Trust/PPO |
$107.22
|
| Rate for Payer: BCN Commercial |
$102.01
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.26
|
| Rate for Payer: Healthscope Commercial |
$131.58
|
| Rate for Payer: Healthscope Whirlpool |
$127.63
|
| Rate for Payer: Mclaren Commercial |
$118.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.84
|
| Rate for Payer: Nomi Health Commercial |
$107.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.79
|
|
|
HC INTERLEUKIN 6, PLASMA
|
Facility
|
OP
|
$131.58
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100710
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$118.42
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$127.63
|
| Rate for Payer: ASR Commercial |
$127.63
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$107.75
|
| Rate for Payer: BCN Commercial |
$102.01
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cash Price |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$123.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$131.58
|
| Rate for Payer: Healthscope Whirlpool |
$127.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$118.42
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.84
|
| Rate for Payer: Nomi Health Commercial |
$107.90
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$250.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC INTERMEDIATE CARE R & B
|
Facility
|
IP
|
$4,896.09
|
|
| Hospital Charge Code |
20600001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$3,182.46 |
| Max. Negotiated Rate |
$4,896.09 |
| Rate for Payer: Aetna Commercial |
$4,406.48
|
| Rate for Payer: ASR ASR |
$4,749.21
|
| Rate for Payer: ASR Commercial |
$4,749.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,989.82
|
| Rate for Payer: BCN Commercial |
$3,795.94
|
| Rate for Payer: Cash Price |
$3,916.87
|
| Rate for Payer: Cofinity Commercial |
$4,602.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.87
|
| Rate for Payer: Healthscope Commercial |
$4,896.09
|
| Rate for Payer: Healthscope Whirlpool |
$4,749.21
|
| Rate for Payer: Mclaren Commercial |
$4,406.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.68
|
| Rate for Payer: Nomi Health Commercial |
$4,014.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,308.56
|
|
|
HC INTERMEDIATE NURSERY CARE
|
Facility
|
IP
|
$2,965.64
|
|
| Hospital Charge Code |
17100001
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$1,927.67 |
| Max. Negotiated Rate |
$2,965.64 |
| Rate for Payer: Aetna Commercial |
$2,669.08
|
| Rate for Payer: ASR ASR |
$2,876.67
|
| Rate for Payer: ASR Commercial |
$2,876.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,416.70
|
| Rate for Payer: BCN Commercial |
$2,299.26
|
| Rate for Payer: Cash Price |
$2,372.51
|
| Rate for Payer: Cofinity Commercial |
$2,787.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,372.51
|
| Rate for Payer: Healthscope Commercial |
$2,965.64
|
| Rate for Payer: Healthscope Whirlpool |
$2,876.67
|
| Rate for Payer: Mclaren Commercial |
$2,669.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,520.79
|
| Rate for Payer: Nomi Health Commercial |
$2,431.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,927.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,609.76
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
OP
|
$536.85
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$483.16
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$520.74
|
| Rate for Payer: ASR Commercial |
$520.74
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$439.63
|
| Rate for Payer: BCN Commercial |
$416.22
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cofinity Commercial |
$504.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$536.85
|
| Rate for Payer: Healthscope Whirlpool |
$520.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$483.16
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.32
|
| Rate for Payer: Nomi Health Commercial |
$440.22
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INTERMEDIATE REPAIR WOUND NECK, HANDS, FEET, GENITALIA 2.6 TO 7.5 CM
|
Facility
|
IP
|
$536.85
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
76100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.95 |
| Max. Negotiated Rate |
$536.85 |
| Rate for Payer: Aetna Commercial |
$483.16
|
| Rate for Payer: ASR ASR |
$520.74
|
| Rate for Payer: ASR Commercial |
$520.74
|
| Rate for Payer: BCBS Trust/PPO |
$437.48
|
| Rate for Payer: BCN Commercial |
$416.22
|
| Rate for Payer: Cash Price |
$429.48
|
| Rate for Payer: Cofinity Commercial |
$504.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.48
|
| Rate for Payer: Healthscope Commercial |
$536.85
|
| Rate for Payer: Healthscope Whirlpool |
$520.74
|
| Rate for Payer: Mclaren Commercial |
$483.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.32
|
| Rate for Payer: Nomi Health Commercial |
$440.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$472.43
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
IP
|
$1,888.39
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,227.45 |
| Max. Negotiated Rate |
$1,888.39 |
| Rate for Payer: Aetna Commercial |
$1,699.55
|
| Rate for Payer: ASR ASR |
$1,831.74
|
| Rate for Payer: ASR Commercial |
$1,831.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,538.85
|
| Rate for Payer: BCN Commercial |
$1,464.07
|
| Rate for Payer: Cash Price |
$1,510.71
|
| Rate for Payer: Cofinity Commercial |
$1,775.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.71
|
| Rate for Payer: Healthscope Commercial |
$1,888.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,831.74
|
| Rate for Payer: Mclaren Commercial |
$1,699.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.13
|
| Rate for Payer: Nomi Health Commercial |
$1,548.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,661.78
|
|
|
HC INTERP REN/VISC PTRA ADD VESS
|
Facility
|
OP
|
$1,888.39
|
|
| Hospital Charge Code |
32000266
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$755.36 |
| Max. Negotiated Rate |
$1,888.39 |
| Rate for Payer: Aetna Commercial |
$1,699.55
|
| Rate for Payer: Aetna Medicare |
$944.20
|
| Rate for Payer: ASR ASR |
$1,831.74
|
| Rate for Payer: ASR Commercial |
$1,831.74
|
| Rate for Payer: BCBS Complete |
$755.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.40
|
| Rate for Payer: BCN Commercial |
$1,464.07
|
| Rate for Payer: Cash Price |
$1,510.71
|
| Rate for Payer: Cofinity Commercial |
$1,775.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.71
|
| Rate for Payer: Healthscope Commercial |
$1,888.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,831.74
|
| Rate for Payer: Mclaren Commercial |
$1,699.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.13
|
| Rate for Payer: Nomi Health Commercial |
$1,548.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,654.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,323.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,661.78
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
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 INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.5 CM OR LESS
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
76100115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$253.43
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$273.14
|
| Rate for Payer: ASR Commercial |
$273.14
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$230.59
|
| Rate for Payer: BCN Commercial |
$218.32
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| 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 |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$281.59
|
| Rate for Payer: Healthscope Whirlpool |
$273.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$253.43
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
OP
|
$309.75
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$278.78
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$300.46
|
| Rate for Payer: ASR Commercial |
$300.46
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$253.65
|
| Rate for Payer: BCN Commercial |
$240.15
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$291.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$309.75
|
| Rate for Payer: Healthscope Whirlpool |
$300.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$278.78
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Nomi Health Commercial |
$254.00
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$478.73
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$382.98
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 2.6 TO 7.5 CM
|
Facility
|
IP
|
$309.75
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
76100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$309.75 |
| Rate for Payer: Aetna Commercial |
$278.78
|
| Rate for Payer: ASR ASR |
$300.46
|
| Rate for Payer: ASR Commercial |
$300.46
|
| Rate for Payer: BCBS Trust/PPO |
$252.42
|
| Rate for Payer: BCN Commercial |
$240.15
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$291.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Healthscope Commercial |
$309.75
|
| Rate for Payer: Healthscope Whirlpool |
$300.46
|
| Rate for Payer: Mclaren Commercial |
$278.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Nomi Health Commercial |
$254.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.58
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
IP
|
$498.64
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$324.12 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$448.78
|
| Rate for Payer: ASR ASR |
$483.68
|
| Rate for Payer: ASR Commercial |
$483.68
|
| Rate for Payer: BCBS Trust/PPO |
$406.34
|
| Rate for Payer: BCN Commercial |
$386.60
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Healthscope Commercial |
$498.64
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Mclaren Commercial |
$448.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.80
|
|
|
HC INTER REPAIR WOUND SCALP, AXILLAE, TRUNK, EXTREMITIES 7.6CM TO 12.5CM
|
Facility
|
OP
|
$498.64
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
76100239
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.82 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$448.78
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$483.68
|
| Rate for Payer: ASR Commercial |
$483.68
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$408.34
|
| Rate for Payer: BCN Commercial |
$386.60
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cash Price |
$398.91
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$498.64
|
| Rate for Payer: Healthscope Whirlpool |
$483.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$448.78
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.84
|
| Rate for Payer: Nomi Health Commercial |
$408.88
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$606.75 |
| Rate for Payer: Aetna Commercial |
$253.43
|
| Rate for Payer: Aetna Medicare |
$391.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: ASR ASR |
$273.14
|
| Rate for Payer: ASR Commercial |
$273.14
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$230.59
|
| Rate for Payer: BCN Commercial |
$218.32
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| 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 |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$281.59
|
| Rate for Payer: Healthscope Whirlpool |
$273.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.45
|
| Rate for Payer: Mclaren Commercial |
$253.43
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$430.60
|
| Rate for Payer: PHP Medicaid |
$209.82
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$478.73
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$382.98
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$606.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP DNSP |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
HC INTER REP WD FACE, EAR, EYELID, NOSE, LIP, MUC MEMBRS 2.5 CM OR LESS
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 12051
|
| Hospital Charge Code |
76100118
|
|
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 INTER REP WD FACE, EARS, EYELIDS, NOSE, LIP, MUC MEMBRANES 2.6 TO 5.0 CM
|
Facility
|
IP
|
$309.75
|
|
|
Service Code
|
CPT 12052
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.34 |
| Max. Negotiated Rate |
$309.75 |
| Rate for Payer: Aetna Commercial |
$278.78
|
| Rate for Payer: ASR ASR |
$300.46
|
| Rate for Payer: ASR Commercial |
$300.46
|
| Rate for Payer: BCBS Trust/PPO |
$252.42
|
| Rate for Payer: BCN Commercial |
$240.15
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cofinity Commercial |
$291.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.80
|
| Rate for Payer: Healthscope Commercial |
$309.75
|
| Rate for Payer: Healthscope Whirlpool |
$300.46
|
| Rate for Payer: Mclaren Commercial |
$278.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.29
|
| Rate for Payer: Nomi Health Commercial |
$254.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.58
|
|
