|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.12
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Advantage |
$507.36
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: Priority Health SBD |
$456.62
|
|
|
HC APPLY SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,986.46
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,251.47 |
| Max. Negotiated Rate |
$1,787.81 |
| Rate for Payer: Aetna Commercial |
$1,688.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cofinity Advantage |
$1,390.52
|
| Rate for Payer: Cofinity Commercial |
$1,708.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,589.17
|
| Rate for Payer: Healthscope Commercial |
$1,787.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,688.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.85
|
| Rate for Payer: PHP Commercial |
$1,688.49
|
| Rate for Payer: Priority Health SBD |
$1,251.47
|
|
|
HC APPLY SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,986.46
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.68 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$1,688.49
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,291.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,186.13
|
| Rate for Payer: BCN Commercial |
$3,186.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cofinity Advantage |
$1,390.52
|
| Rate for Payer: Cofinity Commercial |
$1,708.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,589.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,787.81
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,688.49
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.85
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$1,688.49
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$1,251.47
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,291.20
|
| Rate for Payer: UHC Core |
$1,034.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$780.68
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC APPLY SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,622.12
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,030.49 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$2,228.80
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,704.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,253.77
|
| Rate for Payer: BCN Commercial |
$1,253.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cofinity Advantage |
$1,835.48
|
| Rate for Payer: Cofinity Commercial |
$2,255.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,097.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,359.91
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,228.80
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,966.59
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,228.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$1,651.94
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,704.38
|
| Rate for Payer: UHC Core |
$1,366.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$1,030.49
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC APPLY SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,622.12
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,651.94 |
| Max. Negotiated Rate |
$2,359.91 |
| Rate for Payer: Aetna Commercial |
$2,228.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,704.38
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cofinity Advantage |
$1,835.48
|
| Rate for Payer: Cofinity Commercial |
$2,255.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,097.70
|
| Rate for Payer: Healthscope Commercial |
$2,359.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,228.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,966.59
|
| Rate for Payer: PHP Commercial |
$2,228.80
|
| Rate for Payer: Priority Health SBD |
$1,651.94
|
|
|
HC APPLY SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,656.59
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,390.93 |
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,726.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,217.00
|
| Rate for Payer: BCN Commercial |
$1,217.00
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Advantage |
$1,859.61
|
| Rate for Payer: Cofinity Commercial |
$2,284.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$2,390.93
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$2,258.10
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$1,673.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,726.78
|
| Rate for Payer: UHC Core |
$1,384.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$1,044.04
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC APPLY SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,656.59
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,673.65 |
| Max. Negotiated Rate |
$2,390.93 |
| Rate for Payer: Aetna Commercial |
$2,258.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,726.78
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Advantage |
$1,859.61
|
| Rate for Payer: Cofinity Commercial |
$2,284.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Healthscope Commercial |
$2,390.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: PHP Commercial |
$2,258.10
|
| Rate for Payer: Priority Health SBD |
$1,673.65
|
|
|
HC APPLY SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,435.19
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,534.17 |
| Max. Negotiated Rate |
$2,191.67 |
| Rate for Payer: Aetna Commercial |
$2,069.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.87
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Advantage |
$1,704.63
|
| Rate for Payer: Cofinity Commercial |
$2,094.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Healthscope Commercial |
$2,191.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: PHP Commercial |
$2,069.91
|
| Rate for Payer: Priority Health SBD |
$1,534.17
|
|
|
HC APPLY SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,435.19
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Commercial |
$2,069.91
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,520.16
|
| Rate for Payer: BCN Commercial |
$1,520.16
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Advantage |
$1,704.63
|
| Rate for Payer: Cofinity Commercial |
$2,094.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$2,191.67
|
| Rate for Payer: Mclaren Medicaid |
$385.14
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$2,069.91
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$1,534.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,582.87
|
| Rate for Payer: UHC Core |
$1,268.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$957.03
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC APPLY SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.94 |
| Max. Negotiated Rate |
$851.35 |
| Rate for Payer: Aetna Commercial |
$804.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.86
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Advantage |
$662.16
|
| Rate for Payer: Cofinity Commercial |
$813.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$851.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: PHP Commercial |
$804.05
|
| Rate for Payer: Priority Health SBD |
$595.94
|
|
|
HC APPLY SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.62 |
| Max. Negotiated Rate |
$851.35 |
| Rate for Payer: Aetna Commercial |
$804.05
|
| Rate for Payer: Aetna Medicare |
$472.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.86
|
| Rate for Payer: BCBS Complete |
$378.38
|
| Rate for Payer: BCBS Trust/PPO |
$226.62
|
| Rate for Payer: BCN Commercial |
$226.62
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Advantage |
$662.16
|
| Rate for Payer: Cofinity Commercial |
$813.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$851.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$756.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: PHP Commercial |
$804.05
|
| Rate for Payer: Priority Health SBD |
$595.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.86
|
| Rate for Payer: UHC Core |
$492.83
|
| Rate for Payer: UHC Exchange |
$371.75
|
|
|
HC APPLY SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.94 |
| Max. Negotiated Rate |
$851.35 |
| Rate for Payer: Aetna Commercial |
$804.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.86
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Advantage |
$662.16
|
| Rate for Payer: Cofinity Commercial |
$813.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$851.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: PHP Commercial |
$804.05
|
| Rate for Payer: Priority Health SBD |
$595.94
|
|
|
HC APPLY SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.48 |
| Max. Negotiated Rate |
$851.35 |
| Rate for Payer: Aetna Commercial |
$804.05
|
| Rate for Payer: Aetna Medicare |
$472.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.86
|
| Rate for Payer: BCBS Complete |
$378.38
|
| Rate for Payer: BCBS Trust/PPO |
$189.48
|
| Rate for Payer: BCN Commercial |
$189.48
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Advantage |
$662.16
|
| Rate for Payer: Cofinity Commercial |
$813.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$851.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$756.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: PHP Commercial |
$804.05
|
| Rate for Payer: Priority Health SBD |
$595.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$614.86
|
| Rate for Payer: UHC Core |
$492.83
|
| Rate for Payer: UHC Exchange |
$371.75
|
|
|
HC APPLY SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.12
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Advantage |
$507.36
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: Priority Health SBD |
$456.62
|
|
|
HC APPLY SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: Aetna Medicare |
$362.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.12
|
| Rate for Payer: BCBS Complete |
$289.92
|
| Rate for Payer: BCBS Trust/PPO |
$91.96
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Advantage |
$507.36
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: Priority Health SBD |
$456.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.12
|
| Rate for Payer: UHC Core |
$377.62
|
| Rate for Payer: UHC Exchange |
$284.85
|
|
|
HC APPLY SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.12
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Advantage |
$507.36
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: Priority Health SBD |
$456.62
|
|
|
HC APPLY SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$652.32 |
| Rate for Payer: Aetna Commercial |
$616.08
|
| Rate for Payer: Aetna Medicare |
$362.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.12
|
| Rate for Payer: BCBS Complete |
$289.92
|
| Rate for Payer: BCBS Trust/PPO |
$71.52
|
| Rate for Payer: BCN Commercial |
$71.52
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Advantage |
$507.36
|
| Rate for Payer: Cofinity Commercial |
$623.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$652.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: PHP Commercial |
$616.08
|
| Rate for Payer: Priority Health SBD |
$456.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.12
|
| Rate for Payer: UHC Core |
$377.62
|
| Rate for Payer: UHC Exchange |
$284.85
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
IP
|
$335.44
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.33 |
| Max. Negotiated Rate |
$301.90 |
| Rate for Payer: Aetna Commercial |
$285.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.04
|
| Rate for Payer: Cash Price |
$268.35
|
| Rate for Payer: Cofinity Advantage |
$234.81
|
| Rate for Payer: Cofinity Commercial |
$288.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.35
|
| Rate for Payer: Healthscope Commercial |
$301.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.58
|
| Rate for Payer: PHP Commercial |
$285.12
|
| Rate for Payer: Priority Health SBD |
$211.33
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
OP
|
$335.44
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$301.90 |
| Rate for Payer: Aetna Commercial |
$285.12
|
| Rate for Payer: Aetna Medicare |
$167.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.04
|
| Rate for Payer: BCBS Complete |
$134.18
|
| Rate for Payer: Cash Price |
$268.35
|
| Rate for Payer: Cash Price |
$268.35
|
| Rate for Payer: Cofinity Advantage |
$234.81
|
| Rate for Payer: Cofinity Commercial |
$288.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.35
|
| Rate for Payer: Healthscope Commercial |
$301.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.58
|
| Rate for Payer: PHP Commercial |
$285.12
|
| Rate for Payer: Priority Health SBD |
$211.33
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
IP
|
$200.95
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.62
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cofinity Advantage |
$140.66
|
| Rate for Payer: Cofinity Commercial |
$172.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.76
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.71
|
| Rate for Payer: PHP Commercial |
$170.81
|
| Rate for Payer: Priority Health SBD |
$126.60
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
OP
|
$200.95
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.38 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.81
|
| Rate for Payer: Aetna Medicare |
$100.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.62
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cash Price |
$160.76
|
| Rate for Payer: Cofinity Advantage |
$140.66
|
| Rate for Payer: Cofinity Commercial |
$172.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.76
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.71
|
| Rate for Payer: PHP Commercial |
$170.81
|
| Rate for Payer: Priority Health SBD |
$126.60
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC APT DOWNEY TEST
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health SBD |
$59.25
|
|
|
HC APT DOWNEY TEST
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS MAPPO |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$8.53
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: BCN Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Mclaren Medicaid |
$4.18
|
| Rate for Payer: Mclaren Medicare |
$8.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.40
|
| Rate for Payer: Meridian Medicaid |
$8.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$12.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PACE Medicare |
$7.60
|
| Rate for Payer: PACE SWMI |
$8.00
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$8.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.00
|
| Rate for Payer: Priority Health Medicare |
$8.00
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health Tiered Network |
$6.40
|
| Rate for Payer: Railroad Medicare Medicare |
$8.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.00
|
| Rate for Payer: UHC Core |
$12.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.00
|
| Rate for Payer: UHC Exchange |
$12.00
|
| Rate for Payer: UHC Medicaid |
$4.18
|
| Rate for Payer: UHCCP Medicaid |
$4.18
|
| Rate for Payer: VA VA |
$8.00
|
|
|
HC APTT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: BCBS Complete |
$3.30
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Commercial |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$3.14
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$6.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.01
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$4.81
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.02
|
| Rate for Payer: UHC Core |
$9.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.01
|
| Rate for Payer: UHC Exchange |
$9.02
|
| Rate for Payer: UHC Medicaid |
$3.14
|
| Rate for Payer: UHCCP Medicaid |
$3.14
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC APTT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
