|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
OP
|
$35.50
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: Aetna Medicare |
$9.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.09
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: BCBS MAPPO |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$29.18
|
| Rate for Payer: BCN Commercial |
$27.60
|
| Rate for Payer: BCN Medicare Advantage |
$8.88
|
| Rate for Payer: Cash Price |
$28.40
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.88
|
| Rate for Payer: Healthscope Commercial |
$31.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.18
|
| Rate for Payer: Nomi Health Commercial |
$29.11
|
| Rate for Payer: PACE Senior Care Partners |
$8.43
|
| Rate for Payer: PACE SWMI |
$8.88
|
| Rate for Payer: PHP Commercial |
$30.18
|
| Rate for Payer: PHP Medicare Advantage |
$8.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.08
|
| Rate for Payer: Priority Health HMO/PPO |
$30.88
|
| Rate for Payer: Priority Health Medicare |
$8.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.24
|
| Rate for Payer: UHC Core |
$29.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.88
|
| Rate for Payer: UHC Exchange |
$8.88
|
| Rate for Payer: UHC Medicare Advantage |
$8.88
|
| Rate for Payer: VA VA |
$8.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.62
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$35.50
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: BCBS Trust/PPO |
$28.98
|
| Rate for Payer: BCN Commercial |
$27.43
|
| Rate for Payer: Cash Price |
$28.40
|
| Rate for Payer: Cofinity Commercial |
$30.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.40
|
| Rate for Payer: Healthscope Commercial |
$31.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.18
|
| Rate for Payer: Nomi Health Commercial |
$29.11
|
| Rate for Payer: PHP Commercial |
$30.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.08
|
| Rate for Payer: Priority Health HMO/PPO |
$30.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.24
|
| Rate for Payer: UHC Core |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.62
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna Medicare |
$38.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.81
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS MAPPO |
$37.45
|
| Rate for Payer: BCBS Trust/PPO |
$123.14
|
| Rate for Payer: BCN Commercial |
$116.46
|
| Rate for Payer: BCN Medicare Advantage |
$37.45
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.45
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Mclaren Medicaid |
$32.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.32
|
| Rate for Payer: Meridian Medicaid |
$34.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE Senior Care Partners |
$35.58
|
| Rate for Payer: PACE SWMI |
$37.45
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: PHP Medicare Advantage |
$37.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health HMO/PPO |
$130.32
|
| Rate for Payer: Priority Health Medicare |
$37.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.36
|
| Rate for Payer: Railroad Medicare Medicare |
$37.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Core |
$125.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.45
|
| Rate for Payer: UHC Exchange |
$37.45
|
| Rate for Payer: UHC Medicare Advantage |
$37.45
|
| Rate for Payer: UHCCP Medicaid |
$32.69
|
| Rate for Payer: VA VA |
$37.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.36 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: BCBS Trust/PPO |
$122.27
|
| Rate for Payer: BCN Commercial |
$115.76
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$128.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health HMO/PPO |
$130.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.82
|
| Rate for Payer: UHC Core |
$125.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,947.51
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$462.53 |
| Max. Negotiated Rate |
$1,752.76 |
| Rate for Payer: Aetna Commercial |
$1,655.38
|
| Rate for Payer: Aetna Medicare |
$506.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$608.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$608.60
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$486.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.05
|
| Rate for Payer: BCN Commercial |
$1,514.19
|
| Rate for Payer: BCN Medicare Advantage |
$486.88
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cofinity Commercial |
$1,674.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.88
|
| Rate for Payer: Healthscope Commercial |
$1,752.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,460.63
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.22
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$559.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$1,596.96
|
| Rate for Payer: PACE Senior Care Partners |
$462.53
|
| Rate for Payer: PACE SWMI |
$486.88
|
| Rate for Payer: PHP Commercial |
$1,655.38
|
| Rate for Payer: PHP Medicare Advantage |
$486.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: Priority Health HMO/PPO |
$1,694.33
|
| Rate for Payer: Priority Health Medicare |
$491.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,304.83
|
| Rate for Payer: Railroad Medicare Medicare |
$486.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,713.81
|
| Rate for Payer: UHC Core |
$1,626.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.88
|
| Rate for Payer: UHC Exchange |
$486.88
|
| Rate for Payer: UHC Medicare Advantage |
$486.88
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$486.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,460.63
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,947.51
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,265.88 |
| Max. Negotiated Rate |
$1,752.76 |
| Rate for Payer: Aetna Commercial |
$1,655.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,589.75
|
| Rate for Payer: BCN Commercial |
$1,505.04
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cofinity Commercial |
$1,674.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.01
|
| Rate for Payer: Healthscope Commercial |
$1,752.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,460.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$1,596.96
|
| Rate for Payer: PHP Commercial |
$1,655.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: Priority Health HMO/PPO |
$1,694.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,304.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,713.81
|
| Rate for Payer: UHC Core |
$1,626.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,460.63
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,570.71
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.54 |
| Max. Negotiated Rate |
$2,723.21 |
| Rate for Payer: Aetna Commercial |
$2,185.10
|
| Rate for Payer: Aetna Medicare |
$668.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$803.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$803.35
|
| Rate for Payer: BCBS Complete |
$2,723.21
|
| Rate for Payer: BCBS MAPPO |
$642.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,113.38
|
| Rate for Payer: BCN Commercial |
$1,998.73
|
| Rate for Payer: BCN Medicare Advantage |
$642.68
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cofinity Commercial |
$2,210.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,056.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.68
|
| Rate for Payer: Healthscope Commercial |
$2,313.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,928.03
|
| Rate for Payer: Mclaren Medicaid |
$2,593.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.81
|
| Rate for Payer: Meridian Medicaid |
$2,723.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$739.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$2,107.98
|
| Rate for Payer: PACE Senior Care Partners |
$610.54
|
| Rate for Payer: PACE SWMI |
$642.68
|
| Rate for Payer: PHP Commercial |
$2,185.10
|
| Rate for Payer: PHP Medicare Advantage |
$642.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,593.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: Priority Health HMO/PPO |
$2,236.52
|
| Rate for Payer: Priority Health Medicare |
$649.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,722.38
|
| Rate for Payer: Railroad Medicare Medicare |
$642.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,262.22
|
| Rate for Payer: UHC Core |
$2,146.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.68
|
| Rate for Payer: UHC Exchange |
$642.68
|
| Rate for Payer: UHC Medicare Advantage |
$642.68
|
| Rate for Payer: UHCCP Medicaid |
$2,593.36
|
| Rate for Payer: VA VA |
$642.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,928.03
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,570.71
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,670.96 |
| Max. Negotiated Rate |
$2,313.64 |
| Rate for Payer: Aetna Commercial |
$2,185.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,098.47
|
| Rate for Payer: BCN Commercial |
$1,986.64
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cofinity Commercial |
$2,210.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,056.57
|
| Rate for Payer: Healthscope Commercial |
$2,313.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,928.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$2,107.98
|
| Rate for Payer: PHP Commercial |
$2,185.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: Priority Health HMO/PPO |
$2,236.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,722.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,262.22
|
| Rate for Payer: UHC Core |
$2,146.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,928.03
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,604.50
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,692.92 |
| Max. Negotiated Rate |
$2,344.05 |
| Rate for Payer: Aetna Commercial |
$2,213.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.05
|
| Rate for Payer: BCN Commercial |
$2,012.76
|
| Rate for Payer: Cash Price |
$2,083.60
|
| Rate for Payer: Cofinity Commercial |
$2,239.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,083.60
|
| Rate for Payer: Healthscope Commercial |
$2,344.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,953.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,213.82
|
| Rate for Payer: Nomi Health Commercial |
$2,135.69
|
| Rate for Payer: PHP Commercial |
$2,213.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,692.92
|
| Rate for Payer: Priority Health HMO/PPO |
$2,265.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,291.96
|
| Rate for Payer: UHC Core |
$2,174.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,953.38
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,604.50
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.57 |
| Max. Negotiated Rate |
$2,344.05 |
| Rate for Payer: Aetna Commercial |
$2,213.82
|
| Rate for Payer: Aetna Medicare |
$677.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.91
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$651.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,141.16
|
| Rate for Payer: BCN Commercial |
$2,025.00
|
| Rate for Payer: BCN Medicare Advantage |
$651.12
|
| Rate for Payer: Cash Price |
$2,083.60
|
| Rate for Payer: Cash Price |
$2,083.60
|
| Rate for Payer: Cofinity Commercial |
$2,239.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,083.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$651.12
|
| Rate for Payer: Healthscope Commercial |
$2,344.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,953.38
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.68
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,213.82
|
| Rate for Payer: Nomi Health Commercial |
$2,135.69
|
| Rate for Payer: PACE Senior Care Partners |
$618.57
|
| Rate for Payer: PACE SWMI |
$651.12
|
| Rate for Payer: PHP Commercial |
$2,213.82
|
| Rate for Payer: PHP Medicare Advantage |
$651.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,692.92
|
| Rate for Payer: Priority Health HMO/PPO |
$2,265.92
|
| Rate for Payer: Priority Health Medicare |
$657.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.02
|
| Rate for Payer: Railroad Medicare Medicare |
$651.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,291.96
|
| Rate for Payer: UHC Core |
$2,174.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$651.12
|
| Rate for Payer: UHC Exchange |
$651.12
|
| Rate for Payer: UHC Medicare Advantage |
$651.12
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$651.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,953.38
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,387.44
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.02 |
| Max. Negotiated Rate |
$2,148.70 |
| Rate for Payer: Aetna Commercial |
$2,029.32
|
| Rate for Payer: Aetna Medicare |
$620.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.08
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$596.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,962.71
|
| Rate for Payer: BCN Commercial |
$1,856.23
|
| Rate for Payer: BCN Medicare Advantage |
$596.86
|
| 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: Encore Health Key Benefits Commercial |
$1,909.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$596.86
|
| Rate for Payer: Healthscope Commercial |
$2,148.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,790.58
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.70
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,029.32
|
| Rate for Payer: Nomi Health Commercial |
$1,957.70
|
| Rate for Payer: PACE Senior Care Partners |
$567.02
|
| Rate for Payer: PACE SWMI |
$596.86
|
| Rate for Payer: PHP Commercial |
$2,029.32
|
| Rate for Payer: PHP Medicare Advantage |
$596.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,077.07
|
| Rate for Payer: Priority Health Medicare |
$602.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,599.58
|
| Rate for Payer: Railroad Medicare Medicare |
$596.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,100.95
|
| Rate for Payer: UHC Core |
$1,993.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$596.86
|
| Rate for Payer: UHC Exchange |
$596.86
|
| Rate for Payer: UHC Medicare Advantage |
$596.86
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$596.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,790.58
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,387.44
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,551.84 |
| Max. Negotiated Rate |
$2,148.70 |
| Rate for Payer: Aetna Commercial |
$2,029.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,948.87
|
| Rate for Payer: BCN Commercial |
$1,845.01
|
| Rate for Payer: Cash Price |
$1,909.95
|
| Rate for Payer: Cofinity Commercial |
$2,053.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,909.95
|
| Rate for Payer: Healthscope Commercial |
$2,148.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,790.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,029.32
|
| Rate for Payer: Nomi Health Commercial |
$1,957.70
|
| Rate for Payer: PHP Commercial |
$2,029.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.84
|
| Rate for Payer: Priority Health HMO/PPO |
$2,077.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,599.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,100.95
|
| Rate for Payer: UHC Core |
$1,993.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,790.58
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: BCBS Trust/PPO |
$757.03
|
| Rate for Payer: BCN Commercial |
$716.69
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Healthscope Commercial |
$834.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: PHP Commercial |
$788.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO |
$806.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.10
|
| Rate for Payer: UHC Core |
$774.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.54
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$927.39
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.26 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: Aetna Medicare |
$241.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$289.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$289.81
|
| Rate for Payer: BCBS Complete |
$370.96
|
| Rate for Payer: BCBS MAPPO |
$231.85
|
| Rate for Payer: BCBS Trust/PPO |
$762.41
|
| Rate for Payer: BCN Commercial |
$721.05
|
| Rate for Payer: BCN Medicare Advantage |
$231.85
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.85
|
| Rate for Payer: Healthscope Commercial |
$834.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: PACE Senior Care Partners |
$220.26
|
| Rate for Payer: PACE SWMI |
$231.85
|
| Rate for Payer: PHP Commercial |
$788.28
|
| Rate for Payer: PHP Medicare Advantage |
$231.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO |
$806.83
|
| Rate for Payer: Priority Health Medicare |
$234.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.35
|
| Rate for Payer: Railroad Medicare Medicare |
$231.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.10
|
| Rate for Payer: UHC Core |
$774.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.85
|
| Rate for Payer: UHC Exchange |
$231.85
|
| Rate for Payer: UHC Medicare Advantage |
$231.85
|
| Rate for Payer: VA VA |
$231.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.54
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$927.39
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.26 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: Aetna Medicare |
$241.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$289.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$289.81
|
| Rate for Payer: BCBS Complete |
$370.96
|
| Rate for Payer: BCBS MAPPO |
$231.85
|
| Rate for Payer: BCBS Trust/PPO |
$762.41
|
| Rate for Payer: BCN Commercial |
$721.05
|
| Rate for Payer: BCN Medicare Advantage |
$231.85
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.85
|
| Rate for Payer: Healthscope Commercial |
$834.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: PACE Senior Care Partners |
$220.26
|
| Rate for Payer: PACE SWMI |
$231.85
|
| Rate for Payer: PHP Commercial |
$788.28
|
| Rate for Payer: PHP Medicare Advantage |
$231.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO |
$806.83
|
| Rate for Payer: Priority Health Medicare |
$234.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.35
|
| Rate for Payer: Railroad Medicare Medicare |
$231.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.10
|
| Rate for Payer: UHC Core |
$774.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.85
|
| Rate for Payer: UHC Exchange |
$231.85
|
| Rate for Payer: UHC Medicare Advantage |
$231.85
|
| Rate for Payer: VA VA |
$231.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.54
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: BCBS Trust/PPO |
$757.03
|
| Rate for Payer: BCN Commercial |
$716.69
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Healthscope Commercial |
$834.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: PHP Commercial |
$788.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO |
$806.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.10
|
| Rate for Payer: UHC Core |
$774.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.54
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.88 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: BCBS Trust/PPO |
$580.05
|
| Rate for Payer: BCN Commercial |
$549.14
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.77 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: Aetna Medicare |
$184.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.06
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS MAPPO |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$584.18
|
| Rate for Payer: BCN Commercial |
$552.48
|
| Rate for Payer: BCN Medicare Advantage |
$177.65
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PACE Senior Care Partners |
$168.77
|
| Rate for Payer: PACE SWMI |
$177.65
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: PHP Medicare Advantage |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Medicare |
$179.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: Railroad Medicare Medicare |
$177.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.65
|
| Rate for Payer: UHC Exchange |
$177.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.65
|
| Rate for Payer: VA VA |
$177.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
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 |
$461.88 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: BCBS Trust/PPO |
$580.05
|
| Rate for Payer: BCN Commercial |
$549.14
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
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 |
$168.77 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna Commercial |
$604.00
|
| Rate for Payer: Aetna Medicare |
$184.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.06
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS MAPPO |
$177.65
|
| Rate for Payer: BCBS Trust/PPO |
$584.18
|
| Rate for Payer: BCN Commercial |
$552.48
|
| Rate for Payer: BCN Medicare Advantage |
$177.65
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.65
|
| Rate for Payer: Healthscope Commercial |
$639.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: PACE Senior Care Partners |
$168.77
|
| Rate for Payer: PACE SWMI |
$177.65
|
| Rate for Payer: PHP Commercial |
$604.00
|
| Rate for Payer: PHP Medicare Advantage |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO |
$618.21
|
| Rate for Payer: Priority Health Medicare |
$179.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.10
|
| Rate for Payer: Railroad Medicare Medicare |
$177.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.32
|
| Rate for Payer: UHC Core |
$593.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.65
|
| Rate for Payer: UHC Exchange |
$177.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.65
|
| Rate for Payer: VA VA |
$177.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
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 |
$1,265.88 |
| Max. Negotiated Rate |
$1,752.76 |
| Rate for Payer: Aetna Commercial |
$1,655.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,589.75
|
| Rate for Payer: BCN Commercial |
$1,505.04
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cofinity Commercial |
$1,674.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.01
|
| Rate for Payer: Healthscope Commercial |
$1,752.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,460.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$1,596.96
|
| Rate for Payer: PHP Commercial |
$1,655.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: Priority Health HMO/PPO |
$1,694.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,304.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,713.81
|
| Rate for Payer: UHC Core |
$1,626.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,460.63
|
|
|
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 |
$462.53 |
| Max. Negotiated Rate |
$1,752.76 |
| Rate for Payer: Aetna Commercial |
$1,655.38
|
| Rate for Payer: Aetna Medicare |
$506.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$608.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$608.60
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$486.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.05
|
| Rate for Payer: BCN Commercial |
$1,514.19
|
| Rate for Payer: BCN Medicare Advantage |
$486.88
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cofinity Commercial |
$1,674.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.88
|
| Rate for Payer: Healthscope Commercial |
$1,752.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,460.63
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.22
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$559.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$1,596.96
|
| Rate for Payer: PACE Senior Care Partners |
$462.53
|
| Rate for Payer: PACE SWMI |
$486.88
|
| Rate for Payer: PHP Commercial |
$1,655.38
|
| Rate for Payer: PHP Medicare Advantage |
$486.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: Priority Health HMO/PPO |
$1,694.33
|
| Rate for Payer: Priority Health Medicare |
$491.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,304.83
|
| Rate for Payer: Railroad Medicare Medicare |
$486.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,713.81
|
| Rate for Payer: UHC Core |
$1,626.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.88
|
| Rate for Payer: UHC Exchange |
$486.88
|
| Rate for Payer: UHC Medicare Advantage |
$486.88
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$486.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,460.63
|
|
|
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 |
$1,670.96 |
| Max. Negotiated Rate |
$2,313.64 |
| Rate for Payer: Aetna Commercial |
$2,185.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,098.47
|
| Rate for Payer: BCN Commercial |
$1,986.64
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cofinity Commercial |
$2,210.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,056.57
|
| Rate for Payer: Healthscope Commercial |
$2,313.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,928.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$2,107.98
|
| Rate for Payer: PHP Commercial |
$2,185.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: Priority Health HMO/PPO |
$2,236.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,722.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,262.22
|
| Rate for Payer: UHC Core |
$2,146.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,928.03
|
|
|
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 |
$610.54 |
| Max. Negotiated Rate |
$2,723.21 |
| Rate for Payer: Aetna Commercial |
$2,185.10
|
| Rate for Payer: Aetna Medicare |
$668.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$803.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$803.35
|
| Rate for Payer: BCBS Complete |
$2,723.21
|
| Rate for Payer: BCBS MAPPO |
$642.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,113.38
|
| Rate for Payer: BCN Commercial |
$1,998.73
|
| Rate for Payer: BCN Medicare Advantage |
$642.68
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cofinity Commercial |
$2,210.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,056.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$642.68
|
| Rate for Payer: Healthscope Commercial |
$2,313.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,928.03
|
| Rate for Payer: Mclaren Medicaid |
$2,593.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.81
|
| Rate for Payer: Meridian Medicaid |
$2,723.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$739.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$2,107.98
|
| Rate for Payer: PACE Senior Care Partners |
$610.54
|
| Rate for Payer: PACE SWMI |
$642.68
|
| Rate for Payer: PHP Commercial |
$2,185.10
|
| Rate for Payer: PHP Medicare Advantage |
$642.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,593.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: Priority Health HMO/PPO |
$2,236.52
|
| Rate for Payer: Priority Health Medicare |
$649.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,722.38
|
| Rate for Payer: Railroad Medicare Medicare |
$642.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,262.22
|
| Rate for Payer: UHC Core |
$2,146.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$642.68
|
| Rate for Payer: UHC Exchange |
$642.68
|
| Rate for Payer: UHC Medicare Advantage |
$642.68
|
| Rate for Payer: UHCCP Medicaid |
$2,593.36
|
| Rate for Payer: VA VA |
$642.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,928.03
|
|
|
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 |
$618.57 |
| Max. Negotiated Rate |
$2,344.05 |
| Rate for Payer: Aetna Commercial |
$2,213.82
|
| Rate for Payer: Aetna Medicare |
$677.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.91
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$651.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,141.16
|
| Rate for Payer: BCN Commercial |
$2,025.00
|
| Rate for Payer: BCN Medicare Advantage |
$651.12
|
| Rate for Payer: Cash Price |
$2,083.60
|
| Rate for Payer: Cash Price |
$2,083.60
|
| Rate for Payer: Cofinity Commercial |
$2,239.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,083.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$651.12
|
| Rate for Payer: Healthscope Commercial |
$2,344.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,953.38
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.68
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,213.82
|
| Rate for Payer: Nomi Health Commercial |
$2,135.69
|
| Rate for Payer: PACE Senior Care Partners |
$618.57
|
| Rate for Payer: PACE SWMI |
$651.12
|
| Rate for Payer: PHP Commercial |
$2,213.82
|
| Rate for Payer: PHP Medicare Advantage |
$651.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,692.92
|
| Rate for Payer: Priority Health HMO/PPO |
$2,265.92
|
| Rate for Payer: Priority Health Medicare |
$657.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.02
|
| Rate for Payer: Railroad Medicare Medicare |
$651.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,291.96
|
| Rate for Payer: UHC Core |
$2,174.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$651.12
|
| Rate for Payer: UHC Exchange |
$651.12
|
| Rate for Payer: UHC Medicare Advantage |
$651.12
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$651.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,953.38
|
|
