|
HC APHERESIS
|
Facility
|
IP
|
$2,606.60
|
|
| Hospital Charge Code |
36000006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.95 |
| Max. Negotiated Rate |
$2,606.60 |
| Rate for Payer: Aetna Commercial |
$2,345.94
|
| Rate for Payer: ASR ASR |
$2,528.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,140.54
|
| Rate for Payer: BCN Commercial |
$2,140.54
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cofinity Commercial |
$2,450.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,085.28
|
| Rate for Payer: Healthscope Commercial |
$2,528.40
|
| Rate for Payer: Healthscope Whirlpool |
$2,606.60
|
| Rate for Payer: Mclaren Commercial |
$2,345.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,215.61
|
| Rate for Payer: Nomi Health Commercial |
$2,137.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,293.81
|
|
|
HC APIXABAN
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.05 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCN Commercial |
$128.16
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
|
|
HC APIXABAN
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100758
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.17 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$151.38
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$128.67
|
| Rate for Payer: BCN Commercial |
$128.67
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$146.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$151.38
|
| Rate for Payer: Healthscope Whirlpool |
$156.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$140.45
|
| Rate for Payer: Mclaren Medicaid |
$18.64
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$271.17
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$216.94
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
IP
|
$134.35
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$134.35 |
| Rate for Payer: Aetna Commercial |
$120.92
|
| Rate for Payer: ASR ASR |
$130.32
|
| Rate for Payer: BCBS Trust/PPO |
$110.33
|
| Rate for Payer: BCN Commercial |
$110.33
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.48
|
| Rate for Payer: Healthscope Commercial |
$130.32
|
| Rate for Payer: Healthscope Whirlpool |
$134.35
|
| Rate for Payer: Mclaren Commercial |
$120.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.20
|
| Rate for Payer: Nomi Health Commercial |
$110.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.23
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
OP
|
$134.35
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$120.92
|
| Rate for Payer: Aetna Medicare |
$124.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: ASR ASR |
$130.32
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$110.77
|
| Rate for Payer: BCN Commercial |
$110.77
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cash Price |
$107.48
|
| Rate for Payer: Cofinity Commercial |
$126.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$130.32
|
| Rate for Payer: Healthscope Whirlpool |
$134.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$120.92
|
| Rate for Payer: Mclaren Medicaid |
$124.00
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.20
|
| Rate for Payer: Nomi Health Commercial |
$110.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.76
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$136.40
|
| Rate for Payer: PHP Medicaid |
$66.46
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.25
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health Narrow Network |
$37.00
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$192.20
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP DNSP |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC APOLIPO E GENE, WB
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
31000089
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: ASR ASR |
$333.68
|
| Rate for Payer: BCBS Trust/PPO |
$282.49
|
| Rate for Payer: BCN Commercial |
$282.49
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.20
|
| Rate for Payer: Healthscope Commercial |
$333.68
|
| Rate for Payer: Healthscope Whirlpool |
$344.00
|
| Rate for Payer: Mclaren Commercial |
$309.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.40
|
| Rate for Payer: Nomi Health Commercial |
$282.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.72
|
|
|
HC APOLIPO E GENE, WB
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
31000089
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$171.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$171.25
|
| Rate for Payer: ASR ASR |
$333.68
|
| Rate for Payer: BCBS Complete |
$75.24
|
| Rate for Payer: BCBS MAPPO |
$137.00
|
| Rate for Payer: BCBS Trust/PPO |
$283.63
|
| Rate for Payer: BCN Commercial |
$283.63
|
| Rate for Payer: BCN Medicare Advantage |
$137.00
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$275.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.00
|
| Rate for Payer: Healthscope Commercial |
$333.68
|
| Rate for Payer: Healthscope Whirlpool |
$344.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$137.00
|
| Rate for Payer: Mclaren Commercial |
$309.60
|
| Rate for Payer: Mclaren Medicaid |
$137.00
|
| Rate for Payer: Mclaren Medicare |
$137.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.85
|
| Rate for Payer: Meridian Medicaid |
$75.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.40
|
| Rate for Payer: Nomi Health Commercial |
$282.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.00
|
| Rate for Payer: PACE Medicare |
$130.15
|
| Rate for Payer: PACE SWMI |
$137.00
|
| Rate for Payer: PHP Commercial |
$150.70
|
| Rate for Payer: PHP Medicaid |
$73.43
|
| Rate for Payer: PHP Medicare Advantage |
$137.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$85.40
|
| Rate for Payer: Priority Health Medicare |
$137.00
|
| Rate for Payer: Priority Health Narrow Network |
$68.32
|
| Rate for Payer: Railroad Medicare Medicare |
$137.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$137.00
|
| Rate for Payer: UHC Exchange |
$212.35
|
| Rate for Payer: UHC Medicaid |
$71.65
|
| Rate for Payer: UHCCP DNSP |
$137.00
|
| Rate for Payer: UHCCP Medicaid |
$71.65
|
| Rate for Payer: VA VA |
$137.00
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$53.27 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$21.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.05
|
| Rate for Payer: BCN Commercial |
$42.05
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$49.47
|
| Rate for Payer: Healthscope Whirlpool |
$51.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.09
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: Meridian Medicaid |
$11.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Medicaid |
$11.30
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.27
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health Narrow Network |
$42.61
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.09
|
| Rate for Payer: UHC Exchange |
$32.69
|
| Rate for Payer: UHC Medicaid |
$11.03
|
| Rate for Payer: UHCCP DNSP |
$21.09
|
| Rate for Payer: UHCCP Medicaid |
$11.03
|
| Rate for Payer: VA VA |
$21.09
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.88
|
| Rate for Payer: BCN Commercial |
$41.88
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$49.47
|
| Rate for Payer: Healthscope Whirlpool |
$51.00
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: ASR ASR |
$50.44
|
| Rate for Payer: BCBS Trust/PPO |
$42.70
|
| Rate for Payer: BCN Commercial |
$42.70
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$48.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Healthscope Whirlpool |
$52.00
|
| Rate for Payer: Mclaren Commercial |
$46.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.76
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$53.27 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Medicare |
$21.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: ASR ASR |
$50.44
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$42.87
|
| Rate for Payer: BCN Commercial |
$42.87
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$48.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Healthscope Whirlpool |
$52.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.09
|
| Rate for Payer: Mclaren Commercial |
$46.80
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: Meridian Medicaid |
$11.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$42.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Medicaid |
$11.30
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.27
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health Narrow Network |
$42.61
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.09
|
| Rate for Payer: UHC Exchange |
$32.69
|
| Rate for Payer: UHC Medicaid |
$11.03
|
| Rate for Payer: UHCCP DNSP |
$21.09
|
| Rate for Payer: UHCCP Medicaid |
$11.03
|
| Rate for Payer: VA VA |
$21.09
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$40.33 |
| Rate for Payer: Aetna Commercial |
$36.30
|
| Rate for Payer: ASR ASR |
$39.12
|
| Rate for Payer: BCBS Trust/PPO |
$33.12
|
| Rate for Payer: BCN Commercial |
$33.12
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$37.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$39.12
|
| Rate for Payer: Healthscope Whirlpool |
$40.33
|
| Rate for Payer: Mclaren Commercial |
$36.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.49
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$53.27 |
| Rate for Payer: Aetna Commercial |
$36.30
|
| Rate for Payer: Aetna Medicare |
$21.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: ASR ASR |
$39.12
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$33.25
|
| Rate for Payer: BCN Commercial |
$33.25
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$37.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$39.12
|
| Rate for Payer: Healthscope Whirlpool |
$40.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.09
|
| Rate for Payer: Mclaren Commercial |
$36.30
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: Meridian Medicaid |
$11.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: PHP Medicaid |
$11.30
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.27
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health Narrow Network |
$42.61
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.09
|
| Rate for Payer: UHC Exchange |
$32.69
|
| Rate for Payer: UHC Medicaid |
$11.03
|
| Rate for Payer: UHCCP DNSP |
$21.09
|
| Rate for Payer: UHCCP Medicaid |
$11.03
|
| Rate for Payer: VA VA |
$21.09
|
|
|
HC APPLE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
|
|
HC APPLE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC APPLIANCE BELT
|
Facility
|
IP
|
$25.41
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$25.41 |
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: ASR ASR |
$24.65
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$20.87
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$24.65
|
| Rate for Payer: Healthscope Whirlpool |
$25.41
|
| Rate for Payer: Mclaren Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.60
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.36
|
|
|
HC APPLIANCE BELT
|
Facility
|
OP
|
$25.41
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$25.41 |
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: ASR ASR |
$24.65
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: BCBS Trust/PPO |
$20.95
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: Cash Price |
$20.33
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$24.65
|
| Rate for Payer: Healthscope Whirlpool |
$25.41
|
| Rate for Payer: Mclaren Commercial |
$22.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.60
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.26
|
| Rate for Payer: Priority Health Narrow Network |
$17.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.36
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
OP
|
$36.21
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$36.21 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: ASR ASR |
$35.12
|
| Rate for Payer: BCBS Complete |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$29.86
|
| Rate for Payer: BCN Commercial |
$29.86
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$34.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Healthscope Whirlpool |
$36.21
|
| Rate for Payer: Mclaren Commercial |
$32.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.78
|
| Rate for Payer: Nomi Health Commercial |
$29.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.73
|
| Rate for Payer: Priority Health Narrow Network |
$25.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.86
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$36.21
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$36.21 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: ASR ASR |
$35.12
|
| Rate for Payer: BCBS Trust/PPO |
$29.74
|
| Rate for Payer: BCN Commercial |
$29.74
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$34.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Healthscope Whirlpool |
$36.21
|
| Rate for Payer: Mclaren Commercial |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.78
|
| Rate for Payer: Nomi Health Commercial |
$29.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.86
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$152.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Aetna Commercial |
$137.51
|
| Rate for Payer: ASR ASR |
$148.21
|
| Rate for Payer: BCBS Trust/PPO |
$125.47
|
| Rate for Payer: BCN Commercial |
$125.47
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.23
|
| Rate for Payer: Healthscope Commercial |
$148.21
|
| Rate for Payer: Healthscope Whirlpool |
$152.79
|
| Rate for Payer: Mclaren Commercial |
$137.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.87
|
| Rate for Payer: Nomi Health Commercial |
$125.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.46
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$152.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$152.79 |
| Rate for Payer: Aetna Commercial |
$137.51
|
| Rate for Payer: Aetna Medicare |
$46.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: ASR ASR |
$148.21
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$125.98
|
| Rate for Payer: BCN Commercial |
$125.98
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cash Price |
$122.23
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Healthscope Commercial |
$148.21
|
| Rate for Payer: Healthscope Whirlpool |
$152.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$46.66
|
| Rate for Payer: Mclaren Commercial |
$137.51
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$25.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.87
|
| Rate for Payer: Nomi Health Commercial |
$125.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.59
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Commercial |
$51.33
|
| Rate for Payer: PHP Medicaid |
$25.01
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.87
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Narrow Network |
$107.11
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Exchange |
$72.32
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP DNSP |
$46.66
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,986.46
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,489.85 |
| Max. Negotiated Rate |
$1,986.46 |
| Rate for Payer: Aetna Commercial |
$1,787.81
|
| Rate for Payer: ASR ASR |
$1,926.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.28
|
| Rate for Payer: BCN Commercial |
$1,631.28
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cofinity Commercial |
$1,867.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,589.17
|
| Rate for Payer: Healthscope Commercial |
$1,926.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,986.46
|
| Rate for Payer: Mclaren Commercial |
$1,787.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,688.49
|
| Rate for Payer: Nomi Health Commercial |
$1,628.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,748.08
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,986.46
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$3,186.58 |
| Rate for Payer: Aetna Commercial |
$1,787.81
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$1,926.87
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,637.84
|
| Rate for Payer: BCN Commercial |
$1,637.84
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cash Price |
$1,589.17
|
| Rate for Payer: Cofinity Commercial |
$1,867.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,589.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,926.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,986.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$1,787.81
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,688.49
|
| Rate for Payer: Nomi Health Commercial |
$1,628.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.85
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,740.54
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,392.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,748.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,622.12
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,966.59 |
| Max. Negotiated Rate |
$2,622.12 |
| Rate for Payer: Aetna Commercial |
$2,359.91
|
| Rate for Payer: ASR ASR |
$2,543.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,153.28
|
| Rate for Payer: BCN Commercial |
$2,153.28
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cofinity Commercial |
$2,464.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,097.70
|
| Rate for Payer: Healthscope Commercial |
$2,543.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,622.12
|
| Rate for Payer: Mclaren Commercial |
$2,359.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,228.80
|
| Rate for Payer: Nomi Health Commercial |
$2,150.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,966.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,307.47
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,622.12
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$3,186.58 |
| Rate for Payer: Aetna Commercial |
$2,359.91
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$2,543.46
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,161.94
|
| Rate for Payer: BCN Commercial |
$2,161.94
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cash Price |
$2,097.70
|
| Rate for Payer: Cofinity Commercial |
$2,464.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,097.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$2,543.46
|
| Rate for Payer: Healthscope Whirlpool |
$2,622.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$2,359.91
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,228.80
|
| Rate for Payer: Nomi Health Commercial |
$2,150.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,966.59
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,297.50
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,838.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,307.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
