Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC APOLIPOPROTEIN B

Facility

$50.98

Service Code	CPT 82172
Hospital Charge Code	30100107
Hospital Revenue Code	301
Min. Negotiated Rate	$32.12
Max. Negotiated Rate	$45.88
Rate for Payer: Aetna Commercial	$43.33
Rate for Payer: Aetna New Business (MI Preferred)	$33.14
Rate for Payer: Cash Price	$40.78
Rate for Payer: Cofinity Commercial	$35.69
Rate for Payer: Cofinity Commercial	$43.84
Rate for Payer: Cofinity Medicare Advantage	$35.69
Rate for Payer: Encore Health Key Benefits Commercial	$40.78
Rate for Payer: Healthscope Commercial	$45.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.33
Rate for Payer: PHP Commercial	$43.33
Rate for Payer: Priority Health Cigna Priority Health	$33.14
Rate for Payer: Priority Health SBD	$32.12

HC APOLIPOPROTEIN B LMPP

Facility

$39.54

Service Code	CPT 82172
Hospital Charge Code	30100637
Hospital Revenue Code	301
Min. Negotiated Rate	$11.30
Max. Negotiated Rate	$59.37
Rate for Payer: Aetna Commercial	$33.61
Rate for Payer: Aetna Medicare	$21.93
Rate for Payer: Aetna New Business (MI Preferred)	$25.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$26.36
Rate for Payer: Amish Plain Church Group Commercial	$26.36
Rate for Payer: BCBS Complete	$11.87
Rate for Payer: BCBS MAPPO	$21.09
Rate for Payer: BCN Medicare Advantage	$21.09
Rate for Payer: Cash Price	$31.63
Rate for Payer: Cash Price	$31.63
Rate for Payer: Cofinity Commercial	$34.00
Rate for Payer: Cofinity Commercial	$27.68
Rate for Payer: Cofinity Medicare Advantage	$27.68
Rate for Payer: Encore Health Key Benefits Commercial	$31.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$21.09
Rate for Payer: Healthscope Commercial	$35.59
Rate for Payer: Mclaren Medicaid	$11.30
Rate for Payer: Mclaren Medicare	$21.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$22.14
Rate for Payer: Meridian Medicaid	$11.87
Rate for Payer: MI Amish Medical Board Commercial	$24.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.61
Rate for Payer: PACE Medicare	$20.04
Rate for Payer: PACE SWMI	$21.09
Rate for Payer: PHP Commercial	$33.61
Rate for Payer: PHP Medicare Advantage	$21.09
Rate for Payer: Priority Health Choice Medicaid	$11.30
Rate for Payer: Priority Health Cigna Priority Health	$25.70
Rate for Payer: Priority Health Medicare	$21.09
Rate for Payer: Priority Health SBD	$24.91
Rate for Payer: Railroad Medicare Medicare	$21.09
Rate for Payer: UHC All Payor (Choice/PPO)	$59.37
Rate for Payer: UHC Dual Complete DSNP	$21.09
Rate for Payer: UHC Medicare Advantage	$21.09
Rate for Payer: UHCCP Medicaid	$11.87
Rate for Payer: VA VA	$21.09

HC APOLIPOPROTEIN B LMPP

Facility

$39.54

Service Code	CPT 82172
Hospital Charge Code	30100637
Hospital Revenue Code	301
Min. Negotiated Rate	$24.91
Max. Negotiated Rate	$35.59
Rate for Payer: Aetna Commercial	$33.61
Rate for Payer: Aetna New Business (MI Preferred)	$25.70
Rate for Payer: Cash Price	$31.63
Rate for Payer: Cofinity Commercial	$27.68
Rate for Payer: Cofinity Commercial	$34.00
Rate for Payer: Cofinity Medicare Advantage	$27.68
Rate for Payer: Encore Health Key Benefits Commercial	$31.63
Rate for Payer: Healthscope Commercial	$35.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.61
Rate for Payer: PHP Commercial	$33.61
Rate for Payer: Priority Health Cigna Priority Health	$25.70
Rate for Payer: Priority Health SBD	$24.91

HC APPLE IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200072
Hospital Revenue Code	302
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.53
Rate for Payer: Amish Plain Church Group Commercial	$6.53
Rate for Payer: BCBS Complete	$2.94
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Mclaren Medicaid	$2.80
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.48
Rate for Payer: Meridian Medicaid	$2.94
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.80
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$16.00
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$14.69
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Medicare Advantage	$5.22
Rate for Payer: UHCCP Medicaid	$2.94
Rate for Payer: VA VA	$5.22

HC APPLE IGE

Facility

$25.39

Service Code	CPT 86003
Hospital Charge Code	30200072
Hospital Revenue Code	302
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Commercial	$21.58
Rate for Payer: Aetna New Business (MI Preferred)	$16.50
Rate for Payer: Cash Price	$20.31
Rate for Payer: Cofinity Commercial	$17.77
Rate for Payer: Cofinity Commercial	$21.84
Rate for Payer: Cofinity Medicare Advantage	$17.77
Rate for Payer: Encore Health Key Benefits Commercial	$20.31
Rate for Payer: Healthscope Commercial	$22.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.58
Rate for Payer: PHP Commercial	$21.58
Rate for Payer: Priority Health Cigna Priority Health	$16.50
Rate for Payer: Priority Health SBD	$16.00

HC APPLIANCE BELT

Facility

$24.91

Hospital Charge Code	27000027
Hospital Revenue Code	270
Min. Negotiated Rate	$15.69
Max. Negotiated Rate	$22.42
Rate for Payer: Aetna Commercial	$21.17
Rate for Payer: Aetna New Business (MI Preferred)	$16.19
Rate for Payer: Cash Price	$19.93
Rate for Payer: Cofinity Commercial	$17.44
Rate for Payer: Cofinity Commercial	$21.42
Rate for Payer: Cofinity Medicare Advantage	$17.44
Rate for Payer: Encore Health Key Benefits Commercial	$19.93
Rate for Payer: Healthscope Commercial	$22.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.17
Rate for Payer: PHP Commercial	$21.17
Rate for Payer: Priority Health Cigna Priority Health	$16.19
Rate for Payer: Priority Health SBD	$15.69

HC APPLIANCE BELT

Facility

$24.91

Hospital Charge Code	27000027
Hospital Revenue Code	270
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$22.42
Rate for Payer: Aetna Commercial	$21.17
Rate for Payer: Aetna Medicare	$12.46
Rate for Payer: Aetna New Business (MI Preferred)	$16.19
Rate for Payer: BCBS Complete	$9.96
Rate for Payer: Cash Price	$19.93
Rate for Payer: Cofinity Commercial	$17.44
Rate for Payer: Cofinity Commercial	$21.42
Rate for Payer: Cofinity Medicare Advantage	$17.44
Rate for Payer: Encore Health Key Benefits Commercial	$19.93
Rate for Payer: Healthscope Commercial	$22.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.17
Rate for Payer: PHP Commercial	$21.17
Rate for Payer: Priority Health Cigna Priority Health	$16.19
Rate for Payer: Priority Health SBD	$15.69

HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP

Facility

$35.50

Service Code	CPT 99188
Hospital Charge Code	51000097
Hospital Revenue Code	510
Min. Negotiated Rate	$22.36
Max. Negotiated Rate	$31.95
Rate for Payer: Aetna Commercial	$30.18
Rate for Payer: Aetna New Business (MI Preferred)	$23.07
Rate for Payer: Cash Price	$28.40
Rate for Payer: Cofinity Commercial	$24.85
Rate for Payer: Cofinity Commercial	$30.53
Rate for Payer: Cofinity Medicare Advantage	$24.85
Rate for Payer: Encore Health Key Benefits Commercial	$28.40
Rate for Payer: Healthscope Commercial	$31.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.18
Rate for Payer: PHP Commercial	$30.18
Rate for Payer: Priority Health Cigna Priority Health	$23.07
Rate for Payer: Priority Health SBD	$22.36

HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP

Facility

$35.50

Service Code	CPT 99188
Hospital Charge Code	51000097
Hospital Revenue Code	510
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$31.95
Rate for Payer: Aetna Commercial	$30.18
Rate for Payer: Aetna Medicare	$17.75
Rate for Payer: Aetna New Business (MI Preferred)	$23.07
Rate for Payer: BCBS Complete	$14.20
Rate for Payer: Cash Price	$28.40
Rate for Payer: Cofinity Commercial	$24.85
Rate for Payer: Cofinity Commercial	$30.53
Rate for Payer: Cofinity Medicare Advantage	$24.85
Rate for Payer: Encore Health Key Benefits Commercial	$28.40
Rate for Payer: Healthscope Commercial	$31.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.18
Rate for Payer: PHP Commercial	$30.18
Rate for Payer: Priority Health Cigna Priority Health	$23.07
Rate for Payer: Priority Health SBD	$22.36

HC APPLICATION ON-BODY INJECTOR

Facility

$149.79

Service Code	CPT 96377
Hospital Charge Code	76100069
Hospital Revenue Code	761
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$134.81
Rate for Payer: Aetna Commercial	$127.32
Rate for Payer: Aetna Medicare	$46.80
Rate for Payer: Aetna New Business (MI Preferred)	$97.36
Rate for Payer: Allen County Amish Medical Aid Commercial	$56.25
Rate for Payer: Amish Plain Church Group Commercial	$56.25
Rate for Payer: BCBS Complete	$25.33
Rate for Payer: BCBS MAPPO	$45.00
Rate for Payer: BCN Medicare Advantage	$45.00
Rate for Payer: Cash Price	$119.83
Rate for Payer: Cash Price	$119.83
Rate for Payer: Cofinity Commercial	$128.82
Rate for Payer: Cofinity Commercial	$104.85
Rate for Payer: Cofinity Medicare Advantage	$104.85
Rate for Payer: Encore Health Key Benefits Commercial	$119.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$45.00
Rate for Payer: Healthscope Commercial	$134.81
Rate for Payer: Mclaren Medicaid	$24.12
Rate for Payer: Mclaren Medicare	$45.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$47.25
Rate for Payer: Meridian Medicaid	$25.33
Rate for Payer: MI Amish Medical Board Commercial	$51.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.32
Rate for Payer: PACE Medicare	$42.75
Rate for Payer: PACE SWMI	$45.00
Rate for Payer: PHP Commercial	$127.32
Rate for Payer: PHP Medicare Advantage	$45.00
Rate for Payer: Priority Health Choice Medicaid	$24.12
Rate for Payer: Priority Health Cigna Priority Health	$97.36
Rate for Payer: Priority Health Medicare	$45.00
Rate for Payer: Priority Health SBD	$94.37
Rate for Payer: Railroad Medicare Medicare	$45.00
Rate for Payer: UHC All Payor (Choice/PPO)	$126.67
Rate for Payer: UHC Dual Complete DSNP	$45.00
Rate for Payer: UHC Medicare Advantage	$45.00
Rate for Payer: UHCCP Medicaid	$25.34
Rate for Payer: VA VA	$45.00

HC APPLICATION ON-BODY INJECTOR

Facility

$149.79

Service Code	CPT 96377
Hospital Charge Code	76100069
Hospital Revenue Code	761
Min. Negotiated Rate	$94.37
Max. Negotiated Rate	$134.81
Rate for Payer: Aetna Commercial	$127.32
Rate for Payer: Aetna New Business (MI Preferred)	$97.36
Rate for Payer: Cash Price	$119.83
Rate for Payer: Cofinity Commercial	$104.85
Rate for Payer: Cofinity Commercial	$128.82
Rate for Payer: Cofinity Medicare Advantage	$104.85
Rate for Payer: Encore Health Key Benefits Commercial	$119.83
Rate for Payer: Healthscope Commercial	$134.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.32
Rate for Payer: PHP Commercial	$127.32
Rate for Payer: Priority Health Cigna Priority Health	$97.36
Rate for Payer: Priority Health SBD	$94.37

HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET

Facility

$1,947.51

Service Code	CPT 15277
Hospital Charge Code	76100063
Hospital Revenue Code	761
Min. Negotiated Rate	$1,226.93
Max. Negotiated Rate	$1,752.76
Rate for Payer: Aetna Commercial	$1,655.38
Rate for Payer: Aetna New Business (MI Preferred)	$1,265.88
Rate for Payer: Cash Price	$1,558.01
Rate for Payer: Cofinity Commercial	$1,363.26
Rate for Payer: Cofinity Commercial	$1,674.86
Rate for Payer: Cofinity Medicare Advantage	$1,363.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,558.01
Rate for Payer: Healthscope Commercial	$1,752.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,655.38
Rate for Payer: PHP Commercial	$1,655.38
Rate for Payer: Priority Health Cigna Priority Health	$1,265.88
Rate for Payer: Priority Health SBD	$1,226.93

HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET

Facility

$1,947.51

Service Code	CPT 15277
Hospital Charge Code	76100063
Hospital Revenue Code	761
Min. Negotiated Rate	$956.23
Max. Negotiated Rate	$5,021.81
Rate for Payer: Aetna Commercial	$1,655.38
Rate for Payer: Aetna Medicare	$1,855.37
Rate for Payer: Aetna New Business (MI Preferred)	$1,265.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,230.01
Rate for Payer: Amish Plain Church Group Commercial	$2,230.01
Rate for Payer: BCBS Complete	$1,004.04
Rate for Payer: BCBS MAPPO	$1,784.01
Rate for Payer: BCN Medicare Advantage	$1,784.01
Rate for Payer: Cash Price	$1,558.01
Rate for Payer: Cash Price	$1,558.01
Rate for Payer: Cofinity Commercial	$1,363.26
Rate for Payer: Cofinity Commercial	$1,674.86
Rate for Payer: Cofinity Medicare Advantage	$1,363.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,558.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,784.01
Rate for Payer: Healthscope Commercial	$1,752.76
Rate for Payer: Mclaren Medicaid	$956.23
Rate for Payer: Mclaren Medicare	$1,784.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,873.21
Rate for Payer: Meridian Medicaid	$1,004.04
Rate for Payer: MI Amish Medical Board Commercial	$2,051.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,655.38
Rate for Payer: PACE Medicare	$1,694.81
Rate for Payer: PACE SWMI	$1,784.01
Rate for Payer: PHP Commercial	$1,655.38
Rate for Payer: PHP Medicare Advantage	$1,784.01
Rate for Payer: Priority Health Choice Medicaid	$956.23
Rate for Payer: Priority Health Cigna Priority Health	$1,265.88
Rate for Payer: Priority Health Medicare	$1,784.01
Rate for Payer: Priority Health SBD	$1,226.93
Rate for Payer: Railroad Medicare Medicare	$1,784.01
Rate for Payer: UHC All Payor (Choice/PPO)	$5,021.81
Rate for Payer: UHC Dual Complete DSNP	$1,784.01
Rate for Payer: UHC Medicare Advantage	$1,784.01
Rate for Payer: UHCCP Medicaid	$1,004.40
Rate for Payer: VA VA	$1,784.01

HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS

Facility

$2,570.71

Service Code	CPT 15273
Hospital Charge Code	76100059
Hospital Revenue Code	761
Min. Negotiated Rate	$1,619.55
Max. Negotiated Rate	$10,050.52
Rate for Payer: Aetna Commercial	$2,185.10
Rate for Payer: Aetna Medicare	$3,713.29
Rate for Payer: Aetna New Business (MI Preferred)	$1,670.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,463.09
Rate for Payer: Amish Plain Church Group Commercial	$4,463.09
Rate for Payer: BCBS Complete	$2,009.46
Rate for Payer: BCBS MAPPO	$3,570.47
Rate for Payer: BCN Medicare Advantage	$3,570.47
Rate for Payer: Cash Price	$2,056.57
Rate for Payer: Cash Price	$2,056.57
Rate for Payer: Cofinity Commercial	$1,799.50
Rate for Payer: Cofinity Commercial	$2,210.81
Rate for Payer: Cofinity Medicare Advantage	$1,799.50
Rate for Payer: Encore Health Key Benefits Commercial	$2,056.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,570.47
Rate for Payer: Healthscope Commercial	$2,313.64
Rate for Payer: Mclaren Medicaid	$1,913.77
Rate for Payer: Mclaren Medicare	$3,570.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,748.99
Rate for Payer: Meridian Medicaid	$2,009.46
Rate for Payer: MI Amish Medical Board Commercial	$4,106.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,185.10
Rate for Payer: PACE Medicare	$3,391.95
Rate for Payer: PACE SWMI	$3,570.47
Rate for Payer: PHP Commercial	$2,185.10
Rate for Payer: PHP Medicare Advantage	$3,570.47
Rate for Payer: Priority Health Choice Medicaid	$1,913.77
Rate for Payer: Priority Health Cigna Priority Health	$1,670.96
Rate for Payer: Priority Health Medicare	$3,570.47
Rate for Payer: Priority Health SBD	$1,619.55
Rate for Payer: Railroad Medicare Medicare	$3,570.47
Rate for Payer: UHC All Payor (Choice/PPO)	$10,050.52
Rate for Payer: UHC Dual Complete DSNP	$3,570.47
Rate for Payer: UHC Medicare Advantage	$3,570.47
Rate for Payer: UHCCP Medicaid	$2,010.17
Rate for Payer: VA VA	$3,570.47

HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS

Facility

$2,570.71

Service Code	CPT 15273
Hospital Charge Code	76100059
Hospital Revenue Code	761
Min. Negotiated Rate	$1,619.55
Max. Negotiated Rate	$2,313.64
Rate for Payer: Aetna Commercial	$2,185.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,670.96
Rate for Payer: Cash Price	$2,056.57
Rate for Payer: Cofinity Commercial	$1,799.50
Rate for Payer: Cofinity Commercial	$2,210.81
Rate for Payer: Cofinity Medicare Advantage	$1,799.50
Rate for Payer: Encore Health Key Benefits Commercial	$2,056.57
Rate for Payer: Healthscope Commercial	$2,313.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,185.10
Rate for Payer: PHP Commercial	$2,185.10
Rate for Payer: Priority Health Cigna Priority Health	$1,670.96
Rate for Payer: Priority Health SBD	$1,619.55

HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET

Facility

$2,604.50

Service Code	CPT 15275
Hospital Charge Code	76100061
Hospital Revenue Code	761
Min. Negotiated Rate	$1,640.84
Max. Negotiated Rate	$2,344.05
Rate for Payer: Aetna Commercial	$2,213.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,692.92
Rate for Payer: Cash Price	$2,083.60
Rate for Payer: Cofinity Commercial	$1,823.15
Rate for Payer: Cofinity Commercial	$2,239.87
Rate for Payer: Cofinity Medicare Advantage	$1,823.15
Rate for Payer: Encore Health Key Benefits Commercial	$2,083.60
Rate for Payer: Healthscope Commercial	$2,344.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,213.82
Rate for Payer: PHP Commercial	$2,213.82
Rate for Payer: Priority Health Cigna Priority Health	$1,692.92
Rate for Payer: Priority Health SBD	$1,640.84

HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET

Facility

$2,604.50

Service Code	CPT 15275
Hospital Charge Code	76100061
Hospital Revenue Code	761
Min. Negotiated Rate	$956.23
Max. Negotiated Rate	$5,021.81
Rate for Payer: Aetna Commercial	$2,213.82
Rate for Payer: Aetna Medicare	$1,855.37
Rate for Payer: Aetna New Business (MI Preferred)	$1,692.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,230.01
Rate for Payer: Amish Plain Church Group Commercial	$2,230.01
Rate for Payer: BCBS Complete	$1,004.04
Rate for Payer: BCBS MAPPO	$1,784.01
Rate for Payer: BCN Medicare Advantage	$1,784.01
Rate for Payer: Cash Price	$2,083.60
Rate for Payer: Cash Price	$2,083.60
Rate for Payer: Cofinity Commercial	$1,823.15
Rate for Payer: Cofinity Commercial	$2,239.87
Rate for Payer: Cofinity Medicare Advantage	$1,823.15
Rate for Payer: Encore Health Key Benefits Commercial	$2,083.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,784.01
Rate for Payer: Healthscope Commercial	$2,344.05
Rate for Payer: Mclaren Medicaid	$956.23
Rate for Payer: Mclaren Medicare	$1,784.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,873.21
Rate for Payer: Meridian Medicaid	$1,004.04
Rate for Payer: MI Amish Medical Board Commercial	$2,051.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,213.82
Rate for Payer: PACE Medicare	$1,694.81
Rate for Payer: PACE SWMI	$1,784.01
Rate for Payer: PHP Commercial	$2,213.82
Rate for Payer: PHP Medicare Advantage	$1,784.01
Rate for Payer: Priority Health Choice Medicaid	$956.23
Rate for Payer: Priority Health Cigna Priority Health	$1,692.92
Rate for Payer: Priority Health Medicare	$1,784.01
Rate for Payer: Priority Health SBD	$1,640.84
Rate for Payer: Railroad Medicare Medicare	$1,784.01
Rate for Payer: UHC All Payor (Choice/PPO)	$5,021.81
Rate for Payer: UHC Dual Complete DSNP	$1,784.01
Rate for Payer: UHC Medicare Advantage	$1,784.01
Rate for Payer: UHCCP Medicaid	$1,004.40
Rate for Payer: VA VA	$1,784.01

HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS

Facility

$2,387.44

Service Code	CPT 15271
Hospital Charge Code	76100057
Hospital Revenue Code	761
Min. Negotiated Rate	$956.23
Max. Negotiated Rate	$5,021.81
Rate for Payer: Aetna Commercial	$2,029.32
Rate for Payer: Aetna Medicare	$1,855.37
Rate for Payer: Aetna New Business (MI Preferred)	$1,551.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,230.01
Rate for Payer: Amish Plain Church Group Commercial	$2,230.01
Rate for Payer: BCBS Complete	$1,004.04
Rate for Payer: BCBS MAPPO	$1,784.01
Rate for Payer: BCN Medicare Advantage	$1,784.01
Rate for Payer: Cash Price	$1,909.95
Rate for Payer: Cash Price	$1,909.95
Rate for Payer: Cofinity Commercial	$1,671.21
Rate for Payer: Cofinity Commercial	$2,053.20
Rate for Payer: Cofinity Medicare Advantage	$1,671.21
Rate for Payer: Encore Health Key Benefits Commercial	$1,909.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,784.01
Rate for Payer: Healthscope Commercial	$2,148.70
Rate for Payer: Mclaren Medicaid	$956.23
Rate for Payer: Mclaren Medicare	$1,784.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,873.21
Rate for Payer: Meridian Medicaid	$1,004.04
Rate for Payer: MI Amish Medical Board Commercial	$2,051.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,029.32
Rate for Payer: PACE Medicare	$1,694.81
Rate for Payer: PACE SWMI	$1,784.01
Rate for Payer: PHP Commercial	$2,029.32
Rate for Payer: PHP Medicare Advantage	$1,784.01
Rate for Payer: Priority Health Choice Medicaid	$956.23
Rate for Payer: Priority Health Cigna Priority Health	$1,551.84
Rate for Payer: Priority Health Medicare	$1,784.01
Rate for Payer: Priority Health SBD	$1,504.09
Rate for Payer: Railroad Medicare Medicare	$1,784.01
Rate for Payer: UHC All Payor (Choice/PPO)	$5,021.81
Rate for Payer: UHC Dual Complete DSNP	$1,784.01
Rate for Payer: UHC Medicare Advantage	$1,784.01
Rate for Payer: UHCCP Medicaid	$1,004.40
Rate for Payer: VA VA	$1,784.01

HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS

Facility

$2,387.44

Service Code	CPT 15271
Hospital Charge Code	76100057
Hospital Revenue Code	761
Min. Negotiated Rate	$1,504.09
Max. Negotiated Rate	$2,148.70
Rate for Payer: Aetna Commercial	$2,029.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,551.84
Rate for Payer: Cash Price	$1,909.95
Rate for Payer: Cofinity Commercial	$1,671.21
Rate for Payer: Cofinity Commercial	$2,053.20
Rate for Payer: Cofinity Medicare Advantage	$1,671.21
Rate for Payer: Encore Health Key Benefits Commercial	$1,909.95
Rate for Payer: Healthscope Commercial	$2,148.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,029.32
Rate for Payer: PHP Commercial	$2,029.32
Rate for Payer: Priority Health Cigna Priority Health	$1,551.84
Rate for Payer: Priority Health SBD	$1,504.09

HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET

Facility

$927.39

Service Code	CPT 15278
Hospital Charge Code	76100064
Hospital Revenue Code	761
Min. Negotiated Rate	$584.26
Max. Negotiated Rate	$834.65
Rate for Payer: Aetna Commercial	$788.28
Rate for Payer: Aetna New Business (MI Preferred)	$602.80
Rate for Payer: Cash Price	$741.91
Rate for Payer: Cofinity Commercial	$649.17
Rate for Payer: Cofinity Commercial	$797.56
Rate for Payer: Cofinity Medicare Advantage	$649.17
Rate for Payer: Encore Health Key Benefits Commercial	$741.91
Rate for Payer: Healthscope Commercial	$834.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$788.28
Rate for Payer: PHP Commercial	$788.28
Rate for Payer: Priority Health Cigna Priority Health	$602.80
Rate for Payer: Priority Health SBD	$584.26

HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET

Facility

$927.39

Service Code	CPT 15278
Hospital Charge Code	76100064
Hospital Revenue Code	761
Min. Negotiated Rate	$370.96
Max. Negotiated Rate	$834.65
Rate for Payer: Aetna Commercial	$788.28
Rate for Payer: Aetna Medicare	$463.69
Rate for Payer: Aetna New Business (MI Preferred)	$602.80
Rate for Payer: BCBS Complete	$370.96
Rate for Payer: Cash Price	$741.91
Rate for Payer: Cofinity Commercial	$649.17
Rate for Payer: Cofinity Commercial	$797.56
Rate for Payer: Cofinity Medicare Advantage	$649.17
Rate for Payer: Encore Health Key Benefits Commercial	$741.91
Rate for Payer: Healthscope Commercial	$834.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$788.28
Rate for Payer: PHP Commercial	$788.28
Rate for Payer: Priority Health Cigna Priority Health	$602.80
Rate for Payer: Priority Health SBD	$584.26

HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS

Facility

$927.39

Service Code	CPT 15274
Hospital Charge Code	76100060
Hospital Revenue Code	761
Min. Negotiated Rate	$584.26
Max. Negotiated Rate	$834.65
Rate for Payer: Aetna Commercial	$788.28
Rate for Payer: Aetna New Business (MI Preferred)	$602.80
Rate for Payer: Cash Price	$741.91
Rate for Payer: Cofinity Commercial	$649.17
Rate for Payer: Cofinity Commercial	$797.56
Rate for Payer: Cofinity Medicare Advantage	$649.17
Rate for Payer: Encore Health Key Benefits Commercial	$741.91
Rate for Payer: Healthscope Commercial	$834.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$788.28
Rate for Payer: PHP Commercial	$788.28
Rate for Payer: Priority Health Cigna Priority Health	$602.80
Rate for Payer: Priority Health SBD	$584.26

HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS

Facility

$927.39

Service Code	CPT 15274
Hospital Charge Code	76100060
Hospital Revenue Code	761
Min. Negotiated Rate	$370.96
Max. Negotiated Rate	$834.65
Rate for Payer: Aetna Commercial	$788.28
Rate for Payer: Aetna Medicare	$463.69
Rate for Payer: Aetna New Business (MI Preferred)	$602.80
Rate for Payer: BCBS Complete	$370.96
Rate for Payer: Cash Price	$741.91
Rate for Payer: Cofinity Commercial	$649.17
Rate for Payer: Cofinity Commercial	$797.56
Rate for Payer: Cofinity Medicare Advantage	$649.17
Rate for Payer: Encore Health Key Benefits Commercial	$741.91
Rate for Payer: Healthscope Commercial	$834.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$788.28
Rate for Payer: PHP Commercial	$788.28
Rate for Payer: Priority Health Cigna Priority Health	$602.80
Rate for Payer: Priority Health SBD	$584.26

HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET

Facility

$710.59

Service Code	CPT 15276
Hospital Charge Code	76100062
Hospital Revenue Code	761
Min. Negotiated Rate	$447.67
Max. Negotiated Rate	$639.53
Rate for Payer: Aetna Commercial	$604.00
Rate for Payer: Aetna New Business (MI Preferred)	$461.88
Rate for Payer: Cash Price	$568.47
Rate for Payer: Cofinity Commercial	$497.41
Rate for Payer: Cofinity Commercial	$611.11
Rate for Payer: Cofinity Medicare Advantage	$497.41
Rate for Payer: Encore Health Key Benefits Commercial	$568.47
Rate for Payer: Healthscope Commercial	$639.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$604.00
Rate for Payer: PHP Commercial	$604.00
Rate for Payer: Priority Health Cigna Priority Health	$461.88
Rate for Payer: Priority Health SBD	$447.67

HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET

Facility

$710.59

Service Code	CPT 15276
Hospital Charge Code	76100062
Hospital Revenue Code	761
Min. Negotiated Rate	$284.24
Max. Negotiated Rate	$639.53
Rate for Payer: Aetna Commercial	$604.00
Rate for Payer: Aetna Medicare	$355.30
Rate for Payer: Aetna New Business (MI Preferred)	$461.88
Rate for Payer: BCBS Complete	$284.24
Rate for Payer: Cash Price	$568.47
Rate for Payer: Cofinity Commercial	$497.41
Rate for Payer: Cofinity Commercial	$611.11
Rate for Payer: Cofinity Medicare Advantage	$497.41
Rate for Payer: Encore Health Key Benefits Commercial	$568.47
Rate for Payer: Healthscope Commercial	$639.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$604.00
Rate for Payer: PHP Commercial	$604.00
Rate for Payer: Priority Health Cigna Priority Health	$461.88
Rate for Payer: Priority Health SBD	$447.67

Know your out-of-pocket cost for care.

All Charges