|
HC SHAVE LESION FACE, EARS,EYELIDS, NOSE, LIPS, MUC MEMB 0.6 CM TO 1.0 CM
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 11311
|
| Hospital Charge Code |
76100088
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$276.07 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.5 CM OR LESS
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.5 CM OR LESS
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
76100084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.27
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$102.62
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.6 TO 1.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 11306
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.37
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$112.64
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 0.6 TO 1.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 11306
|
| Hospital Charge Code |
76100085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.1 TO 2.0 CM
|
Facility
|
IP
|
$276.07
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.25 |
| Max. Negotiated Rate |
$276.07 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA 1.1 TO 2.0 CM
|
Facility
|
OP
|
$276.07
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
76100086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$276.07 |
| Rate for Payer: Aetna Commercial |
$248.46
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$267.79
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$214.04
|
| Rate for Payer: BCN Commercial |
$214.04
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cash Price |
$220.86
|
| Rate for Payer: Cofinity Commercial |
$259.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$276.07
|
| Rate for Payer: Healthscope Whirlpool |
$267.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$248.46
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.66
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.22
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$196.01
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.94
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA >2CM
|
Facility
|
OP
|
$488.58
|
|
|
Service Code
|
CPT 11308
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$488.58 |
| Rate for Payer: Aetna Commercial |
$439.72
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$473.92
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$378.80
|
| Rate for Payer: BCN Commercial |
$378.80
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$390.86
|
| Rate for Payer: Cash Price |
$390.86
|
| Rate for Payer: Cofinity Commercial |
$459.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$488.58
|
| Rate for Payer: Healthscope Whirlpool |
$473.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$439.72
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.29
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.61
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$346.89
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.95
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC SHAVE LESION SCALP, NECK, HANDS, FEET, GENITALIA >2CM
|
Facility
|
IP
|
$488.58
|
|
|
Service Code
|
CPT 11308
|
| Hospital Charge Code |
76100289
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.01 |
| Max. Negotiated Rate |
$488.58 |
| Rate for Payer: Aetna Commercial |
$439.72
|
| Rate for Payer: ASR ASR |
$473.92
|
| Rate for Payer: BCBS Trust/PPO |
$378.80
|
| Rate for Payer: BCN Commercial |
$378.80
|
| Rate for Payer: Cash Price |
$390.86
|
| Rate for Payer: Cofinity Commercial |
$459.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.86
|
| Rate for Payer: Healthscope Commercial |
$488.58
|
| Rate for Payer: Healthscope Whirlpool |
$473.92
|
| Rate for Payer: Mclaren Commercial |
$439.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$415.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$429.95
|
|
|
HC SHAVE LESION TRUCK, ARM, LEGS 0.6 TO 1.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.37
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$112.64
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SHAVE LESION TRUCK, ARM, LEGS 0.6 TO 1.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
76100081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 0.5 CM OR LESS
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 0.5 CM OR LESS
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
76100080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.37
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$112.64
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 1.1 TO 2.0 CM
|
Facility
|
OP
|
$158.65
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$222.44 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.37
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$112.64
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS 1.1 TO 2.0 CM
|
Facility
|
IP
|
$158.65
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
76100082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$142.78
|
| Rate for Payer: ASR ASR |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$123.00
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$126.92
|
| Rate for Payer: Cofinity Commercial |
$149.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.92
|
| Rate for Payer: Healthscope Commercial |
$158.65
|
| Rate for Payer: Healthscope Whirlpool |
$153.89
|
| Rate for Payer: Mclaren Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.61
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS OVER 2.0 CM
|
Facility
|
OP
|
$144.23
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$443.04 |
| Rate for Payer: Aetna Commercial |
$129.81
|
| Rate for Payer: Aetna Medicare |
$354.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.04
|
| Rate for Payer: ASR ASR |
$139.90
|
| Rate for Payer: BCBS Complete |
$203.58
|
| Rate for Payer: BCBS MAPPO |
$354.43
|
| Rate for Payer: BCBS Trust/PPO |
$111.82
|
| Rate for Payer: BCN Commercial |
$111.82
|
| Rate for Payer: BCN Medicare Advantage |
$354.43
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$135.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.43
|
| Rate for Payer: Healthscope Commercial |
$144.23
|
| Rate for Payer: Healthscope Whirlpool |
$139.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.43
|
| Rate for Payer: Mclaren Commercial |
$129.81
|
| Rate for Payer: Mclaren Medicaid |
$193.87
|
| Rate for Payer: Mclaren Medicare |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$203.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PACE Medicare |
$336.71
|
| Rate for Payer: PACE SWMI |
$354.43
|
| Rate for Payer: PHP Commercial |
$389.87
|
| Rate for Payer: PHP Medicaid |
$193.87
|
| Rate for Payer: PHP Medicare Advantage |
$354.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.25
|
| Rate for Payer: Priority Health Medicare |
$354.43
|
| Rate for Payer: Priority Health Narrow Network |
$102.40
|
| Rate for Payer: Railroad Medicare Medicare |
$354.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.92
|
| Rate for Payer: UHC Medicare Advantage |
$365.06
|
| Rate for Payer: VA VA |
$354.43
|
|
|
HC SHAVE LESION TRUNK, ARM, LEGS OVER 2.0 CM
|
Facility
|
IP
|
$144.23
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
76100083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$144.23 |
| Rate for Payer: Aetna Commercial |
$129.81
|
| Rate for Payer: ASR ASR |
$139.90
|
| Rate for Payer: BCBS Trust/PPO |
$111.82
|
| Rate for Payer: BCN Commercial |
$111.82
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$135.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.38
|
| Rate for Payer: Healthscope Commercial |
$144.23
|
| Rate for Payer: Healthscope Whirlpool |
$139.90
|
| Rate for Payer: Mclaren Commercial |
$129.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.92
|
|
|
HC SHEEP SORREL IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SHEEP SORREL IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC SHINGLES VACCINE
|
Facility
|
IP
|
$271.52
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
63600063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.06 |
| Max. Negotiated Rate |
$271.52 |
| Rate for Payer: Aetna Commercial |
$244.37
|
| Rate for Payer: ASR ASR |
$263.37
|
| Rate for Payer: BCBS Trust/PPO |
$210.51
|
| Rate for Payer: BCN Commercial |
$210.51
|
| Rate for Payer: Cash Price |
$217.22
|
| Rate for Payer: Cofinity Commercial |
$255.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.22
|
| Rate for Payer: Healthscope Commercial |
$271.52
|
| Rate for Payer: Healthscope Whirlpool |
$263.37
|
| Rate for Payer: Mclaren Commercial |
$244.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.94
|
|
|
HC SHINGLES VACCINE
|
Facility
|
OP
|
$271.52
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
63600063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.61 |
| Max. Negotiated Rate |
$271.52 |
| Rate for Payer: Aetna Commercial |
$244.37
|
| Rate for Payer: ASR ASR |
$263.37
|
| Rate for Payer: BCBS Complete |
$108.61
|
| Rate for Payer: BCBS Trust/PPO |
$210.51
|
| Rate for Payer: BCN Commercial |
$210.51
|
| Rate for Payer: Cash Price |
$217.22
|
| Rate for Payer: Cofinity Commercial |
$255.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.22
|
| Rate for Payer: Healthscope Commercial |
$271.52
|
| Rate for Payer: Healthscope Whirlpool |
$263.37
|
| Rate for Payer: Mclaren Commercial |
$244.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.08
|
| Rate for Payer: Priority Health Narrow Network |
$192.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.94
|
|
|
HC SHRIMP IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.65
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SHRIMP IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200061
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: ASR ASR |
$24.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$24.89
|
| Rate for Payer: Healthscope Whirlpool |
$24.14
|
| Rate for Payer: Mclaren Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.90
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC SICKLE CELL CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500011
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.06
|
| Rate for Payer: Priority Health Narrow Network |
$158.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
