|
HC APPLIANCE BELT
|
Facility
|
IP
|
$24.42
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.76
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.09
|
| Rate for Payer: Priority Health SBD |
$15.38
|
|
|
HC APPLIANCE BELT
|
Facility
|
OP
|
$24.42
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.76
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.09
|
| Rate for Payer: Priority Health SBD |
$15.38
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$34.80
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$31.32 |
| Rate for Payer: Aetna Commercial |
$29.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.62
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$31.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.58
|
| Rate for Payer: PHP Commercial |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.36
|
| Rate for Payer: Priority Health SBD |
$21.92
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
OP
|
$34.80
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$31.32 |
| Rate for Payer: Aetna Commercial |
$29.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.62
|
| Rate for Payer: BCBS Complete |
$13.92
|
| Rate for Payer: BCBS Trust/PPO |
$21.50
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cash Price |
$27.84
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$31.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.58
|
| Rate for Payer: PHP Commercial |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.36
|
| Rate for Payer: Priority Health SBD |
$21.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.45
|
| Rate for Payer: UHC Exchange |
$9.50
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$146.85
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$132.16 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: Aetna Medicare |
$43.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.84
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS MAPPO |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$75.16
|
| Rate for Payer: BCN Medicare Advantage |
$42.27
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Cofinity Commercial |
$102.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.27
|
| Rate for Payer: Healthscope Commercial |
$132.16
|
| Rate for Payer: Mclaren Medicaid |
$23.12
|
| Rate for Payer: Mclaren Medicare |
$42.27
|
| Rate for Payer: Meridian Medicaid |
$24.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PACE Medicare |
$40.16
|
| Rate for Payer: PACE SWMI |
$42.27
|
| Rate for Payer: PHP Commercial |
$124.82
|
| Rate for Payer: PHP Medicare Advantage |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.59
|
| Rate for Payer: Priority Health Medicare |
$42.27
|
| Rate for Payer: Priority Health Narrow Network |
$99.67
|
| Rate for Payer: Priority Health SBD |
$92.52
|
| Rate for Payer: Railroad Medicare Medicare |
$42.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.27
|
| Rate for Payer: UHC Exchange |
$18.01
|
| Rate for Payer: UHC Medicare Advantage |
$43.54
|
| Rate for Payer: VA VA |
$42.27
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$146.85
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.52 |
| Max. Negotiated Rate |
$132.16 |
| Rate for Payer: Aetna Commercial |
$124.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.45
|
| Rate for Payer: Cash Price |
$117.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Cofinity Commercial |
$102.80
|
| Rate for Payer: Healthscope Commercial |
$132.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.82
|
| Rate for Payer: PHP Commercial |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.80
|
| Rate for Payer: Priority Health SBD |
$92.52
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,909.32
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,202.87 |
| Max. Negotiated Rate |
$1,718.39 |
| Rate for Payer: Aetna Commercial |
$1,622.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.06
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cofinity Commercial |
$1,336.52
|
| Rate for Payer: Cofinity Commercial |
$1,642.02
|
| Rate for Payer: Healthscope Commercial |
$1,718.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,622.92
|
| Rate for Payer: PHP Commercial |
$1,622.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.52
|
| Rate for Payer: Priority Health SBD |
$1,202.87
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,909.32
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.44 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$1,622.92
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,415.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cofinity Commercial |
$1,642.02
|
| Rate for Payer: Cofinity Commercial |
$1,336.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$1,718.39
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,622.92
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$1,622.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Priority Health SBD |
$1,202.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$216.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,520.30
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$9,754.38 |
| Rate for Payer: Aetna Commercial |
$2,142.26
|
| Rate for Payer: Aetna Medicare |
$3,319.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,638.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,990.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,990.30
|
| Rate for Payer: BCBS Complete |
$1,833.62
|
| Rate for Payer: BCBS MAPPO |
$3,192.24
|
| Rate for Payer: BCBS Trust/PPO |
$950.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,192.24
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$2,167.46
|
| Rate for Payer: Cofinity Commercial |
$1,764.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,192.24
|
| Rate for Payer: Healthscope Commercial |
$2,268.27
|
| Rate for Payer: Mclaren Medicaid |
$1,746.16
|
| Rate for Payer: Mclaren Medicare |
$3,192.24
|
| Rate for Payer: Meridian Medicaid |
$1,833.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,351.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,671.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,142.26
|
| Rate for Payer: PACE Medicare |
$3,032.63
|
| Rate for Payer: PACE SWMI |
$3,192.24
|
| Rate for Payer: PHP Commercial |
$2,142.26
|
| Rate for Payer: PHP Medicare Advantage |
$3,192.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,746.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,754.38
|
| Rate for Payer: Priority Health Medicare |
$3,192.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,803.50
|
| Rate for Payer: Priority Health SBD |
$1,587.79
|
| Rate for Payer: Railroad Medicare Medicare |
$3,192.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,192.24
|
| Rate for Payer: UHC Exchange |
$189.92
|
| Rate for Payer: UHC Medicare Advantage |
$3,288.01
|
| Rate for Payer: VA VA |
$3,192.24
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,520.30
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,587.79 |
| Max. Negotiated Rate |
$2,268.27 |
| Rate for Payer: Aetna Commercial |
$2,142.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,638.20
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$1,764.21
|
| Rate for Payer: Cofinity Commercial |
$2,167.46
|
| Rate for Payer: Healthscope Commercial |
$2,268.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,142.26
|
| Rate for Payer: PHP Commercial |
$2,142.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.21
|
| Rate for Payer: Priority Health SBD |
$1,587.79
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,553.43
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,608.66 |
| Max. Negotiated Rate |
$2,298.09 |
| Rate for Payer: Aetna Commercial |
$2,170.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,659.73
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cofinity Commercial |
$1,787.40
|
| Rate for Payer: Cofinity Commercial |
$2,195.95
|
| Rate for Payer: Healthscope Commercial |
$2,298.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,170.42
|
| Rate for Payer: PHP Commercial |
$2,170.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,787.40
|
| Rate for Payer: Priority Health SBD |
$1,608.66
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,553.43
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.70 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$2,170.42
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,659.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$922.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cofinity Commercial |
$1,787.40
|
| Rate for Payer: Cofinity Commercial |
$2,195.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$2,298.09
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,170.42
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$2,170.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,787.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Priority Health SBD |
$1,608.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$90.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,340.63
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,474.60 |
| Max. Negotiated Rate |
$2,106.57 |
| Rate for Payer: Aetna Commercial |
$1,989.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.41
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cofinity Commercial |
$1,638.44
|
| Rate for Payer: Cofinity Commercial |
$2,012.94
|
| Rate for Payer: Healthscope Commercial |
$2,106.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,989.54
|
| Rate for Payer: PHP Commercial |
$1,989.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.44
|
| Rate for Payer: Priority Health SBD |
$1,474.60
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,340.63
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.86 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$1,989.54
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cofinity Commercial |
$1,638.44
|
| Rate for Payer: Cofinity Commercial |
$2,012.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$2,106.57
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,989.54
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$1,989.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Priority Health SBD |
$1,474.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$81.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$909.21
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.80 |
| Max. Negotiated Rate |
$818.29 |
| Rate for Payer: Aetna Commercial |
$772.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.99
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$636.45
|
| Rate for Payer: Cofinity Commercial |
$781.92
|
| Rate for Payer: Healthscope Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: PHP Commercial |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health SBD |
$572.80
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$909.21
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$818.29 |
| Rate for Payer: Aetna Commercial |
$772.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.99
|
| Rate for Payer: BCBS Complete |
$363.68
|
| Rate for Payer: BCBS Trust/PPO |
$171.81
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$636.45
|
| Rate for Payer: Cofinity Commercial |
$781.92
|
| Rate for Payer: Healthscope Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: PHP Commercial |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health SBD |
$572.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.43
|
| Rate for Payer: UHC Exchange |
$54.03
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$909.21
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.80 |
| Max. Negotiated Rate |
$818.29 |
| Rate for Payer: Aetna Commercial |
$772.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.99
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$636.45
|
| Rate for Payer: Cofinity Commercial |
$781.92
|
| Rate for Payer: Healthscope Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: PHP Commercial |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health SBD |
$572.80
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$909.21
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$818.29 |
| Rate for Payer: Aetna Commercial |
$772.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.99
|
| Rate for Payer: BCBS Complete |
$363.68
|
| Rate for Payer: BCBS Trust/PPO |
$143.65
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$636.45
|
| Rate for Payer: Cofinity Commercial |
$781.92
|
| Rate for Payer: Healthscope Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: PHP Commercial |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health SBD |
$572.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.54
|
| Rate for Payer: UHC Exchange |
$43.22
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$69.72
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$438.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.65
|
| Rate for Payer: UHC Exchange |
$24.23
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$696.66
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$438.90
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$54.22
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$438.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.01
|
| Rate for Payer: UHC Exchange |
$16.37
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$696.66
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.90 |
| Max. Negotiated Rate |
$626.99 |
| Rate for Payer: Aetna Commercial |
$592.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.83
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$487.66
|
| Rate for Payer: Cofinity Commercial |
$599.13
|
| Rate for Payer: Healthscope Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: PHP Commercial |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health SBD |
$438.90
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,909.32
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,202.87 |
| Max. Negotiated Rate |
$1,718.39 |
| Rate for Payer: Aetna Commercial |
$1,622.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.06
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cofinity Commercial |
$1,336.52
|
| Rate for Payer: Cofinity Commercial |
$1,642.02
|
| Rate for Payer: Healthscope Commercial |
$1,718.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,622.92
|
| Rate for Payer: PHP Commercial |
$1,622.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.52
|
| Rate for Payer: Priority Health SBD |
$1,202.87
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,909.32
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.44 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$1,622.92
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,415.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cofinity Commercial |
$1,336.52
|
| Rate for Payer: Cofinity Commercial |
$1,642.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$1,718.39
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,622.92
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$1,622.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Priority Health SBD |
$1,202.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$216.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,520.30
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,587.79 |
| Max. Negotiated Rate |
$2,268.27 |
| Rate for Payer: Aetna Commercial |
$2,142.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,638.20
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$1,764.21
|
| Rate for Payer: Cofinity Commercial |
$2,167.46
|
| Rate for Payer: Healthscope Commercial |
$2,268.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,142.26
|
| Rate for Payer: PHP Commercial |
$2,142.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.21
|
| Rate for Payer: Priority Health SBD |
$1,587.79
|
|
