|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,656.59
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,992.44 |
| Max. Negotiated Rate |
$2,656.59 |
| Rate for Payer: Aetna Commercial |
$2,390.93
|
| Rate for Payer: ASR ASR |
$2,576.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,181.59
|
| Rate for Payer: BCN Commercial |
$2,181.59
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Commercial |
$2,497.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Healthscope Commercial |
$2,576.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,656.59
|
| Rate for Payer: Mclaren Commercial |
$2,390.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Nomi Health Commercial |
$2,178.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,337.80
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,656.59
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,656.59 |
| Rate for Payer: Aetna Commercial |
$2,390.93
|
| Rate for Payer: Aetna Medicare |
$736.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: ASR ASR |
$2,576.89
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,190.36
|
| Rate for Payer: BCN Commercial |
$2,190.36
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Commercial |
$2,497.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$2,576.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,656.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$736.41
|
| Rate for Payer: Mclaren Commercial |
$2,390.93
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$404.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Nomi Health Commercial |
$2,178.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$810.05
|
| Rate for Payer: PHP Medicaid |
$394.72
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,327.70
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,862.27
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,337.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$1,141.44
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP DNSP |
$736.41
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,435.19
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,435.19 |
| Rate for Payer: Aetna Commercial |
$2,191.67
|
| Rate for Payer: Aetna Medicare |
$736.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: ASR ASR |
$2,362.13
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,007.81
|
| Rate for Payer: BCN Commercial |
$2,007.81
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Commercial |
$2,289.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$2,362.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,435.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$736.41
|
| Rate for Payer: Mclaren Commercial |
$2,191.67
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$404.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Nomi Health Commercial |
$1,996.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$810.05
|
| Rate for Payer: PHP Medicaid |
$394.72
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,133.71
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,707.07
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,142.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$1,141.44
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP DNSP |
$736.41
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,435.19
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,826.39 |
| Max. Negotiated Rate |
$2,435.19 |
| Rate for Payer: Aetna Commercial |
$2,191.67
|
| Rate for Payer: ASR ASR |
$2,362.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,999.78
|
| Rate for Payer: BCN Commercial |
$1,999.78
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Commercial |
$2,289.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Healthscope Commercial |
$2,362.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,435.19
|
| Rate for Payer: Mclaren Commercial |
$2,191.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Nomi Health Commercial |
$1,996.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,142.97
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.46 |
| Max. Negotiated Rate |
$945.94 |
| Rate for Payer: Aetna Commercial |
$851.35
|
| Rate for Payer: ASR ASR |
$917.56
|
| Rate for Payer: BCBS Trust/PPO |
$776.81
|
| Rate for Payer: BCN Commercial |
$776.81
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$917.56
|
| Rate for Payer: Healthscope Whirlpool |
$945.94
|
| Rate for Payer: Mclaren Commercial |
$851.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.43
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$945.94 |
| Rate for Payer: Aetna Commercial |
$851.35
|
| Rate for Payer: Aetna Medicare |
$350.00
|
| Rate for Payer: ASR ASR |
$917.56
|
| Rate for Payer: BCBS Complete |
$378.38
|
| Rate for Payer: BCBS Trust/PPO |
$779.93
|
| Rate for Payer: BCN Commercial |
$779.93
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$917.56
|
| Rate for Payer: Healthscope Whirlpool |
$945.94
|
| Rate for Payer: Mclaren Commercial |
$851.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$756.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$828.83
|
| Rate for Payer: Priority Health Narrow Network |
$663.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.43
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$945.94 |
| Rate for Payer: Aetna Commercial |
$851.35
|
| Rate for Payer: Aetna Medicare |
$350.00
|
| Rate for Payer: ASR ASR |
$917.56
|
| Rate for Payer: BCBS Complete |
$378.38
|
| Rate for Payer: BCBS Trust/PPO |
$779.93
|
| Rate for Payer: BCN Commercial |
$779.93
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$917.56
|
| Rate for Payer: Healthscope Whirlpool |
$945.94
|
| Rate for Payer: Mclaren Commercial |
$851.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$756.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$828.83
|
| Rate for Payer: Priority Health Narrow Network |
$663.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.43
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.46 |
| Max. Negotiated Rate |
$945.94 |
| Rate for Payer: Aetna Commercial |
$851.35
|
| Rate for Payer: ASR ASR |
$917.56
|
| Rate for Payer: BCBS Trust/PPO |
$776.81
|
| Rate for Payer: BCN Commercial |
$776.81
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$917.56
|
| Rate for Payer: Healthscope Whirlpool |
$945.94
|
| Rate for Payer: Mclaren Commercial |
$851.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.43
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.60 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$652.32
|
| Rate for Payer: ASR ASR |
$703.06
|
| Rate for Payer: BCBS Trust/PPO |
$595.21
|
| Rate for Payer: BCN Commercial |
$595.21
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$681.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$703.06
|
| Rate for Payer: Healthscope Whirlpool |
$724.80
|
| Rate for Payer: Mclaren Commercial |
$652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.82
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.18 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$652.32
|
| Rate for Payer: Aetna Medicare |
$268.18
|
| Rate for Payer: ASR ASR |
$703.06
|
| Rate for Payer: BCBS Complete |
$289.92
|
| Rate for Payer: BCBS Trust/PPO |
$597.60
|
| Rate for Payer: BCN Commercial |
$597.60
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$681.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$703.06
|
| Rate for Payer: Healthscope Whirlpool |
$724.80
|
| Rate for Payer: Mclaren Commercial |
$652.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$635.07
|
| Rate for Payer: Priority Health Narrow Network |
$508.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.82
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$724.80
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.60 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$652.32
|
| Rate for Payer: ASR ASR |
$703.06
|
| Rate for Payer: BCBS Trust/PPO |
$595.21
|
| Rate for Payer: BCN Commercial |
$595.21
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$681.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$703.06
|
| Rate for Payer: Healthscope Whirlpool |
$724.80
|
| Rate for Payer: Mclaren Commercial |
$652.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.82
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.18 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$652.32
|
| Rate for Payer: Aetna Medicare |
$268.18
|
| Rate for Payer: ASR ASR |
$703.06
|
| Rate for Payer: BCBS Complete |
$289.92
|
| Rate for Payer: BCBS Trust/PPO |
$597.60
|
| Rate for Payer: BCN Commercial |
$597.60
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$681.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$703.06
|
| Rate for Payer: Healthscope Whirlpool |
$724.80
|
| Rate for Payer: Mclaren Commercial |
$652.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$635.07
|
| Rate for Payer: Priority Health Narrow Network |
$508.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.82
|
|
|
HC APPLY SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,986.46
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
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 SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,986.46
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
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 SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,622.12
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
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 SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,622.12
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
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
|
|
|
HC APPLY SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,656.59
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,992.44 |
| Max. Negotiated Rate |
$2,656.59 |
| Rate for Payer: Aetna Commercial |
$2,390.93
|
| Rate for Payer: ASR ASR |
$2,576.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,181.59
|
| Rate for Payer: BCN Commercial |
$2,181.59
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Commercial |
$2,497.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Healthscope Commercial |
$2,576.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,656.59
|
| Rate for Payer: Mclaren Commercial |
$2,390.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Nomi Health Commercial |
$2,178.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,337.80
|
|
|
HC APPLY SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,656.59
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,656.59 |
| Rate for Payer: Aetna Commercial |
$2,390.93
|
| Rate for Payer: Aetna Medicare |
$736.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: ASR ASR |
$2,576.89
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,190.36
|
| Rate for Payer: BCN Commercial |
$2,190.36
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cash Price |
$2,125.27
|
| Rate for Payer: Cofinity Commercial |
$2,497.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,125.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$2,576.89
|
| Rate for Payer: Healthscope Whirlpool |
$2,656.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$736.41
|
| Rate for Payer: Mclaren Commercial |
$2,390.93
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$404.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,258.10
|
| Rate for Payer: Nomi Health Commercial |
$2,178.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,992.44
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$810.05
|
| Rate for Payer: PHP Medicaid |
$394.72
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,327.70
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,862.27
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,337.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$1,141.44
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP DNSP |
$736.41
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC APPLY SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,435.19
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,826.39 |
| Max. Negotiated Rate |
$2,435.19 |
| Rate for Payer: Aetna Commercial |
$2,191.67
|
| Rate for Payer: ASR ASR |
$2,362.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,999.78
|
| Rate for Payer: BCN Commercial |
$1,999.78
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Commercial |
$2,289.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Healthscope Commercial |
$2,362.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,435.19
|
| Rate for Payer: Mclaren Commercial |
$2,191.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Nomi Health Commercial |
$1,996.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,142.97
|
|
|
HC APPLY SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,435.19
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,435.19 |
| Rate for Payer: Aetna Commercial |
$2,191.67
|
| Rate for Payer: Aetna Medicare |
$736.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: ASR ASR |
$2,362.13
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,007.81
|
| Rate for Payer: BCN Commercial |
$2,007.81
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cash Price |
$1,948.15
|
| Rate for Payer: Cofinity Commercial |
$2,289.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,948.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$2,362.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,435.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$736.41
|
| Rate for Payer: Mclaren Commercial |
$2,191.67
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$404.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,069.91
|
| Rate for Payer: Nomi Health Commercial |
$1,996.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,826.39
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$810.05
|
| Rate for Payer: PHP Medicaid |
$394.72
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,133.71
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,707.07
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,142.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Exchange |
$1,141.44
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP DNSP |
$736.41
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
HC APPLY SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.46 |
| Max. Negotiated Rate |
$945.94 |
| Rate for Payer: Aetna Commercial |
$851.35
|
| Rate for Payer: ASR ASR |
$917.56
|
| Rate for Payer: BCBS Trust/PPO |
$776.81
|
| Rate for Payer: BCN Commercial |
$776.81
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$917.56
|
| Rate for Payer: Healthscope Whirlpool |
$945.94
|
| Rate for Payer: Mclaren Commercial |
$851.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.43
|
|
|
HC APPLY SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$945.94 |
| Rate for Payer: Aetna Commercial |
$851.35
|
| Rate for Payer: Aetna Medicare |
$350.00
|
| Rate for Payer: ASR ASR |
$917.56
|
| Rate for Payer: BCBS Complete |
$378.38
|
| Rate for Payer: BCBS Trust/PPO |
$779.93
|
| Rate for Payer: BCN Commercial |
$779.93
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$917.56
|
| Rate for Payer: Healthscope Whirlpool |
$945.94
|
| Rate for Payer: Mclaren Commercial |
$851.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$756.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$828.83
|
| Rate for Payer: Priority Health Narrow Network |
$663.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.43
|
|
|
HC APPLY SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$945.94
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$945.94 |
| Rate for Payer: Aetna Commercial |
$851.35
|
| Rate for Payer: Aetna Medicare |
$350.00
|
| Rate for Payer: ASR ASR |
$917.56
|
| Rate for Payer: BCBS Complete |
$378.38
|
| Rate for Payer: BCBS Trust/PPO |
$779.93
|
| Rate for Payer: BCN Commercial |
$779.93
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$917.56
|
| Rate for Payer: Healthscope Whirlpool |
$945.94
|
| Rate for Payer: Mclaren Commercial |
$851.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$756.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$828.83
|
| Rate for Payer: Priority Health Narrow Network |
$663.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.43
|
|
|
HC APPLY SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$945.94
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.46 |
| Max. Negotiated Rate |
$945.94 |
| Rate for Payer: Aetna Commercial |
$851.35
|
| Rate for Payer: ASR ASR |
$917.56
|
| Rate for Payer: BCBS Trust/PPO |
$776.81
|
| Rate for Payer: BCN Commercial |
$776.81
|
| Rate for Payer: Cash Price |
$756.75
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.75
|
| Rate for Payer: Healthscope Commercial |
$917.56
|
| Rate for Payer: Healthscope Whirlpool |
$945.94
|
| Rate for Payer: Mclaren Commercial |
$851.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$804.05
|
| Rate for Payer: Nomi Health Commercial |
$775.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$832.43
|
|
|
HC APPLY SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$724.80
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.18 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$652.32
|
| Rate for Payer: Aetna Medicare |
$268.18
|
| Rate for Payer: ASR ASR |
$703.06
|
| Rate for Payer: BCBS Complete |
$289.92
|
| Rate for Payer: BCBS Trust/PPO |
$597.60
|
| Rate for Payer: BCN Commercial |
$597.60
|
| Rate for Payer: Cash Price |
$579.84
|
| Rate for Payer: Cofinity Commercial |
$681.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$579.84
|
| Rate for Payer: Healthscope Commercial |
$703.06
|
| Rate for Payer: Healthscope Whirlpool |
$724.80
|
| Rate for Payer: Mclaren Commercial |
$652.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.08
|
| Rate for Payer: Nomi Health Commercial |
$594.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$543.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$635.07
|
| Rate for Payer: Priority Health Narrow Network |
$508.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$637.82
|
|
