|
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 |
$13.14 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Aetna American Axle |
$23.08
|
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: Aetna Medicare |
$17.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.08
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.74
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: Cash Price |
$28.40
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$24.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.62
|
| 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 |
$23.08
|
| Rate for Payer: Priority Health SBD |
$22.36
|
| Rate for Payer: UMR Bronson Commercial |
$13.14
|
| 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 |
$15.62 |
| Max. Negotiated Rate |
$31.95 |
| Rate for Payer: Aetna American Axle |
$23.08
|
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.08
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$24.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.62
|
| 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 |
$23.08
|
| Rate for Payer: Priority Health SBD |
$22.36
|
| Rate for Payer: UMR Bronson Commercial |
$15.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.62
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$134.81 |
| Rate for Payer: Aetna American Axle |
$97.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$104.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$65.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.34
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$142.07 |
| Rate for Payer: Aetna American Axle |
$97.36
|
| Rate for Payer: Aetna Commercial |
$127.32
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$96.15
|
| Rate for Payer: BCN Commercial |
$96.15
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| 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 |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$134.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.34
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$135.63
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$127.32
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.07
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.66
|
| Rate for Payer: Priority Health SBD |
$94.37
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$16.99
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: UMR Bronson Commercial |
$55.42
|
| Rate for Payer: VA VA |
$45.21
|
| 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 |
$215.01 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna American Axle |
$1,265.88
|
| Rate for Payer: Aetna Commercial |
$1,655.38
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,334.22
|
| Rate for Payer: BCN Commercial |
$4,334.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,558.01
|
| 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: Cofinity Commercial |
$1,363.26
|
| 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 |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$1,752.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,363.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,460.63
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,655.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$1,226.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.51
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$215.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$720.58
|
| Rate for Payer: VA VA |
$1,792.24
|
| 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 |
$856.90 |
| Max. Negotiated Rate |
$1,752.76 |
| Rate for Payer: Aetna American Axle |
$1,265.88
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,363.26
|
| 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: 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
|
| Rate for Payer: UMR Bronson Commercial |
$856.90
|
| 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 |
$188.70 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna American Axle |
$1,670.96
|
| Rate for Payer: Aetna Commercial |
$2,185.10
|
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,670.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,705.55
|
| Rate for Payer: BCN Commercial |
$1,705.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Cash Price |
$2,056.57
|
| 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: Cofinity Commercial |
$1,799.50
|
| 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 |
$3,586.95
|
| Rate for Payer: Healthscope Commercial |
$2,313.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,799.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,928.03
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Commercial |
$2,185.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Priority Health SBD |
$1,619.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.57
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$188.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: UMR Bronson Commercial |
$951.16
|
| Rate for Payer: VA VA |
$3,586.95
|
| 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 |
$1,131.11 |
| Max. Negotiated Rate |
$2,313.64 |
| Rate for Payer: Aetna American Axle |
$1,670.96
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,799.50
|
| 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: 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,131.11
|
| 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
|
OP
|
$2,604.50
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.59 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: BCN Commercial |
$1,655.54
|
| Rate for Payer: Aetna American Axle |
$1,692.92
|
| Rate for Payer: Aetna Commercial |
$2,213.82
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,692.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$2,083.60
|
| 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: Cofinity Commercial |
$1,823.15
|
| 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 |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$2,344.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,823.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,953.38
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,213.82
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$2,213.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,692.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$1,640.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.55
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$89.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$963.66
|
| Rate for Payer: VA VA |
$1,792.24
|
| 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
|
IP
|
$2,604.50
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,145.98 |
| Max. Negotiated Rate |
$2,344.05 |
| Rate for Payer: Aetna American Axle |
$1,692.92
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,823.15
|
| 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: 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,145.98
|
| 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
|
IP
|
$2,387.44
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.47 |
| Max. Negotiated Rate |
$2,148.70 |
| Rate for Payer: Aetna American Axle |
$1,551.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,671.21
|
| 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: 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,050.47
|
| 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
|
OP
|
$2,387.44
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.83 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna American Axle |
$1,551.84
|
| Rate for Payer: Aetna Commercial |
$2,029.32
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,551.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,067.93
|
| Rate for Payer: BCN Commercial |
$2,067.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,909.95
|
| 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 |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$2,148.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,671.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,790.58
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,029.32
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$2,029.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$1,504.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.91
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$80.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$883.35
|
| Rate for Payer: VA VA |
$1,792.24
|
| 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 |
$408.05 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna American Axle |
$602.80
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$649.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$408.05
|
| 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 |
$53.85 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna American Axle |
$602.80
|
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: Aetna Medicare |
$463.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.80
|
| Rate for Payer: BCBS Complete |
$370.96
|
| Rate for Payer: BCBS Trust/PPO |
$308.28
|
| Rate for Payer: BCN Commercial |
$308.28
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$649.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.24
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$53.85
|
| Rate for Payer: UMR Bronson Commercial |
$343.13
|
| 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 |
$43.17 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna American Axle |
$602.80
|
| Rate for Payer: Aetna Commercial |
$788.28
|
| Rate for Payer: Aetna Medicare |
$463.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.80
|
| Rate for Payer: BCBS Complete |
$370.96
|
| Rate for Payer: BCBS Trust/PPO |
$257.75
|
| Rate for Payer: BCN Commercial |
$257.75
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$797.56
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$649.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.49
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$43.17
|
| Rate for Payer: UMR Bronson Commercial |
$343.13
|
| 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 |
$408.05 |
| Max. Negotiated Rate |
$834.65 |
| Rate for Payer: Aetna American Axle |
$602.80
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$649.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.54
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$408.05
|
| 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 |
$312.66 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna American Axle |
$461.88
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$497.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$312.66
|
| 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 |
$24.13 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$461.88
|
| 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: BCBS Trust/PPO |
$125.10
|
| Rate for Payer: BCN Commercial |
$125.10
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Cofinity Commercial |
$497.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$497.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.54
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$24.13
|
| Rate for Payer: UMR Bronson Commercial |
$262.92
|
| 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 |
$312.66 |
| Max. Negotiated Rate |
$639.53 |
| Rate for Payer: Aetna American Axle |
$461.88
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$497.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$312.66
|
| 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 |
$16.31 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$461.88
|
| 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: BCBS Trust/PPO |
$97.29
|
| Rate for Payer: BCN Commercial |
$97.29
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$611.11
|
| Rate for Payer: Cofinity Commercial |
$497.41
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$497.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.94
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.94
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$16.31
|
| Rate for Payer: UMR Bronson Commercial |
$262.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.94
|
|
|
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 |
$215.01 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna American Axle |
$1,265.88
|
| Rate for Payer: Aetna Commercial |
$1,655.38
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,334.22
|
| Rate for Payer: BCN Commercial |
$4,334.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,558.01
|
| 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: Cofinity Commercial |
$1,363.26
|
| 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 |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$1,752.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,363.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,460.63
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,655.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$1,226.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.51
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$215.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: UMR Bronson Commercial |
$720.58
|
| Rate for Payer: VA VA |
$1,792.24
|
| 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
|
IP
|
$1,947.51
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$856.90 |
| Max. Negotiated Rate |
$1,752.76 |
| Rate for Payer: Aetna American Axle |
$1,265.88
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,363.26
|
| 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: 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
|
| Rate for Payer: UMR Bronson Commercial |
$856.90
|
| 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 |
$1,131.11 |
| Max. Negotiated Rate |
$2,313.64 |
| Rate for Payer: Aetna American Axle |
$1,670.96
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,799.50
|
| 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: 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,131.11
|
| 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 |
$188.70 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna American Axle |
$1,670.96
|
| Rate for Payer: Aetna Commercial |
$2,185.10
|
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,670.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,705.55
|
| Rate for Payer: BCN Commercial |
$1,705.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Cash Price |
$2,056.57
|
| 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: Cofinity Commercial |
$1,799.50
|
| 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 |
$3,586.95
|
| Rate for Payer: Healthscope Commercial |
$2,313.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,799.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,928.03
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Commercial |
$2,185.10
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Priority Health SBD |
$1,619.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.57
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$188.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: UMR Bronson Commercial |
$951.16
|
| Rate for Payer: VA VA |
$3,586.95
|
| 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
|
IP
|
$2,604.50
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,145.98 |
| Max. Negotiated Rate |
$2,344.05 |
| Rate for Payer: Aetna American Axle |
$1,692.92
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,823.15
|
| 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: 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,145.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,953.38
|
|
