|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
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 TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
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
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,947.51
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
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 LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,947.51
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
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 LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,570.71
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
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 LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,570.71
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
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 LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,604.50
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
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 LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,604.50
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
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 LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,387.44
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
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 LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,387.44
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
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 |
$2,053.20
|
| Rate for Payer: Cofinity Commercial |
$1,671.21
|
| 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 LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$927.39
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
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 LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
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 LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$927.39
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
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 LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
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 LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
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 LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
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
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
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
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
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 SPLINT/CAST COMPLEX
|
Facility
|
IP
|
$328.86
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.18 |
| Max. Negotiated Rate |
$295.97 |
| Rate for Payer: Aetna Commercial |
$279.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.76
|
| Rate for Payer: Cash Price |
$263.09
|
| Rate for Payer: Cofinity Commercial |
$230.20
|
| Rate for Payer: Cofinity Commercial |
$282.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.09
|
| Rate for Payer: Healthscope Commercial |
$295.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.53
|
| Rate for Payer: PHP Commercial |
$279.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.76
|
| Rate for Payer: Priority Health SBD |
$207.18
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
OP
|
$328.86
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$295.97 |
| Rate for Payer: Aetna Commercial |
$279.53
|
| Rate for Payer: Aetna Medicare |
$164.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.76
|
| Rate for Payer: BCBS Complete |
$131.54
|
| Rate for Payer: Cash Price |
$263.09
|
| Rate for Payer: Cofinity Commercial |
$230.20
|
| Rate for Payer: Cofinity Commercial |
$282.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.09
|
| Rate for Payer: Healthscope Commercial |
$295.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.53
|
| Rate for Payer: PHP Commercial |
$279.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.76
|
| Rate for Payer: Priority Health SBD |
$207.18
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
IP
|
$197.01
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$177.31 |
| Rate for Payer: Aetna Commercial |
$167.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.06
|
| Rate for Payer: Cash Price |
$157.61
|
| Rate for Payer: Cofinity Commercial |
$137.91
|
| Rate for Payer: Cofinity Commercial |
$169.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.61
|
| Rate for Payer: Healthscope Commercial |
$177.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.46
|
| Rate for Payer: PHP Commercial |
$167.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.06
|
| Rate for Payer: Priority Health SBD |
$124.12
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
OP
|
$197.01
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$177.31 |
| Rate for Payer: Aetna Commercial |
$167.46
|
| Rate for Payer: Aetna Medicare |
$98.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.06
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: Cash Price |
$157.61
|
| Rate for Payer: Cofinity Commercial |
$137.91
|
| Rate for Payer: Cofinity Commercial |
$169.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.61
|
| Rate for Payer: Healthscope Commercial |
$177.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.46
|
| Rate for Payer: PHP Commercial |
$167.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.06
|
| Rate for Payer: Priority Health SBD |
$124.12
|
|
|
HC APT DOWNEY TEST
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| 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 |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.00
|
| Rate for Payer: BCN Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$4.29
|
| 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 |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: PACE Medicare |
$7.60
|
| Rate for Payer: PACE SWMI |
$8.00
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health Medicare |
$8.00
|
| Rate for Payer: Priority Health SBD |
$58.09
|
| Rate for Payer: Railroad Medicare Medicare |
$8.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.00
|
| Rate for Payer: UHC Medicare Advantage |
$8.00
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: VA VA |
$8.00
|
|
|
HC APT DOWNEY TEST
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health SBD |
$58.09
|
|
|
HC APTT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| 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 |
$3.38
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| 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 |
$3.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.01
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHCCP Medicaid |
$3.38
|
| Rate for Payer: VA VA |
$6.01
|
|
