|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
OP
|
$39.54
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$48.31 |
| Rate for Payer: Aetna Commercial |
$35.59
|
| 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 |
$38.35
|
| Rate for Payer: ASR Commercial |
$38.35
|
| Rate for Payer: BCBS Complete |
$11.87
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$32.38
|
| Rate for Payer: BCN Commercial |
$30.66
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$37.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Healthscope Whirlpool |
$38.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.09
|
| Rate for Payer: Mclaren Commercial |
$35.59
|
| Rate for Payer: Mclaren Medicaid |
$11.30
|
| 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 |
$11.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| 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 |
$11.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.31
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health Narrow Network |
$38.65
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.09
|
| Rate for Payer: UHC Exchange |
$32.69
|
| Rate for Payer: UHC Medicare Advantage |
$21.09
|
| Rate for Payer: UHCCP DNSP |
$21.09
|
| Rate for Payer: UHCCP Medicaid |
$11.30
|
| Rate for Payer: VA VA |
$21.09
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna Commercial |
$35.59
|
| Rate for Payer: ASR ASR |
$38.35
|
| Rate for Payer: ASR Commercial |
$38.35
|
| Rate for Payer: BCBS Trust/PPO |
$32.22
|
| Rate for Payer: BCN Commercial |
$30.66
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Commercial |
$37.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Healthscope Whirlpool |
$38.35
|
| Rate for Payer: Mclaren Commercial |
$35.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Nomi Health Commercial |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.80
|
|
|
HC APPLE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.79
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$17.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC APPLE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.39 |
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: ASR ASR |
$24.63
|
| Rate for Payer: ASR Commercial |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$25.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.63
|
| Rate for Payer: Mclaren Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.34
|
|
|
HC APPLIANCE BELT
|
Facility
|
OP
|
$24.91
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$24.91 |
| Rate for Payer: Aetna Commercial |
$22.42
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: ASR ASR |
$24.16
|
| Rate for Payer: ASR Commercial |
$24.16
|
| Rate for Payer: BCBS Complete |
$9.96
|
| Rate for Payer: BCBS Trust/PPO |
$20.40
|
| Rate for Payer: BCN Commercial |
$19.31
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cofinity Commercial |
$23.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$24.91
|
| Rate for Payer: Healthscope Whirlpool |
$24.16
|
| Rate for Payer: Mclaren Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.17
|
| Rate for Payer: Nomi Health Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.83
|
| Rate for Payer: Priority Health Narrow Network |
$17.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.92
|
|
|
HC APPLIANCE BELT
|
Facility
|
IP
|
$24.91
|
|
| Hospital Charge Code |
27000027
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$24.91 |
| Rate for Payer: Aetna Commercial |
$22.42
|
| Rate for Payer: ASR ASR |
$24.16
|
| Rate for Payer: ASR Commercial |
$24.16
|
| Rate for Payer: BCBS Trust/PPO |
$20.30
|
| Rate for Payer: BCN Commercial |
$19.31
|
| Rate for Payer: Cash Price |
$19.93
|
| Rate for Payer: Cofinity Commercial |
$23.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$24.91
|
| Rate for Payer: Healthscope Whirlpool |
$24.16
|
| Rate for Payer: Mclaren Commercial |
$22.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.17
|
| Rate for Payer: Nomi Health Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.92
|
|
|
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 |
$14.20 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Aetna Commercial |
$31.95
|
| Rate for Payer: Aetna Medicare |
$17.75
|
| Rate for Payer: ASR ASR |
$34.44
|
| Rate for Payer: ASR Commercial |
$34.44
|
| Rate for Payer: BCBS Complete |
$14.20
|
| Rate for Payer: BCBS Trust/PPO |
$29.07
|
| Rate for Payer: BCN Commercial |
$27.52
|
| Rate for Payer: Cash Price |
$28.40
|
| Rate for Payer: Cofinity Commercial |
$33.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.40
|
| Rate for Payer: Healthscope Commercial |
$35.50
|
| Rate for Payer: Healthscope Whirlpool |
$34.44
|
| Rate for Payer: Mclaren Commercial |
$31.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.18
|
| Rate for Payer: Nomi Health Commercial |
$29.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.11
|
| Rate for Payer: Priority Health Narrow Network |
$24.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.24
|
|
|
HC APPLICATION OF TOPICAL FLUORIDE VARNISH BY PHYS/QHP
|
Facility
|
IP
|
$35.50
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
51000097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.08 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Aetna Commercial |
$31.95
|
| Rate for Payer: ASR ASR |
$34.44
|
| Rate for Payer: ASR Commercial |
$34.44
|
| Rate for Payer: BCBS Trust/PPO |
$28.93
|
| Rate for Payer: BCN Commercial |
$27.52
|
| Rate for Payer: Cash Price |
$28.40
|
| Rate for Payer: Cofinity Commercial |
$33.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.40
|
| Rate for Payer: Healthscope Commercial |
$35.50
|
| Rate for Payer: Healthscope Whirlpool |
$34.44
|
| Rate for Payer: Mclaren Commercial |
$31.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.18
|
| Rate for Payer: Nomi Health Commercial |
$29.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.24
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$149.79 |
| Rate for Payer: Aetna Commercial |
$134.81
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: ASR ASR |
$145.30
|
| Rate for Payer: ASR Commercial |
$145.30
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$122.66
|
| Rate for Payer: BCN Commercial |
$116.13
|
| 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 |
$140.80
|
| 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 |
$149.79
|
| Rate for Payer: Healthscope Whirlpool |
$145.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$45.21
|
| Rate for Payer: Mclaren Commercial |
$134.81
|
| 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 |
$122.83
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Medicaid |
$24.23
|
| 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 |
$131.25
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$105.00
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP DNSP |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: VA VA |
$45.21
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$149.79
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
76100069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.36 |
| Max. Negotiated Rate |
$149.79 |
| Rate for Payer: Aetna Commercial |
$134.81
|
| Rate for Payer: ASR ASR |
$145.30
|
| Rate for Payer: ASR Commercial |
$145.30
|
| Rate for Payer: BCBS Trust/PPO |
$122.06
|
| Rate for Payer: BCN Commercial |
$116.13
|
| Rate for Payer: Cash Price |
$119.83
|
| Rate for Payer: Cofinity Commercial |
$140.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.83
|
| Rate for Payer: Healthscope Commercial |
$149.79
|
| Rate for Payer: Healthscope Whirlpool |
$145.30
|
| Rate for Payer: Mclaren Commercial |
$134.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.32
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.82
|
|
|
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 |
$960.64 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$1,752.76
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| 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: ASR ASR |
$1,889.08
|
| Rate for Payer: ASR Commercial |
$1,889.08
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,594.82
|
| Rate for Payer: BCN Commercial |
$1,509.90
|
| 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: Cofinity Commercial |
$1,830.66
|
| 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 |
$1,947.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,889.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$1,752.76
|
| 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 |
$1,596.96
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| 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 |
$1,706.41
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,365.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,713.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,947.51
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
76100063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,265.88 |
| Max. Negotiated Rate |
$1,947.51 |
| Rate for Payer: Aetna Commercial |
$1,752.76
|
| Rate for Payer: ASR ASR |
$1,889.08
|
| Rate for Payer: ASR Commercial |
$1,889.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,587.03
|
| Rate for Payer: BCN Commercial |
$1,509.90
|
| Rate for Payer: Cash Price |
$1,558.01
|
| Rate for Payer: Cofinity Commercial |
$1,830.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,558.01
|
| Rate for Payer: Healthscope Commercial |
$1,947.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,889.08
|
| Rate for Payer: Mclaren Commercial |
$1,752.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,655.38
|
| Rate for Payer: Nomi Health Commercial |
$1,596.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,265.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,713.81
|
|
|
HC APPLY HC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,570.71
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
76100059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,670.96 |
| Max. Negotiated Rate |
$2,570.71 |
| Rate for Payer: Aetna Commercial |
$2,313.64
|
| Rate for Payer: ASR ASR |
$2,493.59
|
| Rate for Payer: ASR Commercial |
$2,493.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,094.87
|
| Rate for Payer: BCN Commercial |
$1,993.07
|
| Rate for Payer: Cash Price |
$2,056.57
|
| Rate for Payer: Cofinity Commercial |
$2,416.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,056.57
|
| Rate for Payer: Healthscope Commercial |
$2,570.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,493.59
|
| Rate for Payer: Mclaren Commercial |
$2,313.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,185.10
|
| Rate for Payer: Nomi Health Commercial |
$2,107.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,670.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,262.22
|
|
|
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 |
$1,670.96 |
| Max. Negotiated Rate |
$5,559.77 |
| Rate for Payer: Aetna Commercial |
$2,313.64
|
| Rate for Payer: Aetna Medicare |
$3,586.95
|
| 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: ASR ASR |
$2,493.59
|
| Rate for Payer: ASR Commercial |
$2,493.59
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,105.15
|
| Rate for Payer: BCN Commercial |
$1,993.07
|
| 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: Cofinity Commercial |
$2,416.47
|
| 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 |
$2,570.71
|
| Rate for Payer: Healthscope Whirlpool |
$2,493.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,586.95
|
| Rate for Payer: Mclaren Commercial |
$2,313.64
|
| 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 |
$2,107.98
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Commercial |
$3,945.64
|
| Rate for Payer: PHP Medicaid |
$1,922.61
|
| 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 |
$2,252.46
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,802.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,262.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Exchange |
$5,559.77
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP DNSP |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$1,922.61
|
| Rate for Payer: VA VA |
$3,586.95
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,604.50
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
76100061
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,692.92 |
| Max. Negotiated Rate |
$2,604.50 |
| Rate for Payer: Aetna Commercial |
$2,344.05
|
| Rate for Payer: ASR ASR |
$2,526.36
|
| Rate for Payer: ASR Commercial |
$2,526.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,122.41
|
| Rate for Payer: BCN Commercial |
$2,019.27
|
| Rate for Payer: Cash Price |
$2,083.60
|
| Rate for Payer: Cofinity Commercial |
$2,448.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,083.60
|
| Rate for Payer: Healthscope Commercial |
$2,604.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,526.36
|
| Rate for Payer: Mclaren Commercial |
$2,344.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,213.82
|
| Rate for Payer: Nomi Health Commercial |
$2,135.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,692.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,291.96
|
|
|
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 |
$960.64 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$2,344.05
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| 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: ASR ASR |
$2,526.36
|
| Rate for Payer: ASR Commercial |
$2,526.36
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,132.83
|
| Rate for Payer: BCN Commercial |
$2,019.27
|
| 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: Cofinity Commercial |
$2,448.23
|
| 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 |
$2,604.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,526.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$2,344.05
|
| 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 |
$2,135.69
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| 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 |
$2,282.06
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,825.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,291.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
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 |
$960.64 |
| Max. Negotiated Rate |
$2,777.97 |
| Rate for Payer: Aetna Commercial |
$2,148.70
|
| Rate for Payer: Aetna Medicare |
$1,792.24
|
| 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: ASR ASR |
$2,315.82
|
| Rate for Payer: ASR Commercial |
$2,315.82
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,955.07
|
| Rate for Payer: BCN Commercial |
$1,850.98
|
| 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: Cofinity Commercial |
$2,244.19
|
| 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 |
$2,387.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,315.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,792.24
|
| Rate for Payer: Mclaren Commercial |
$2,148.70
|
| 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 |
$1,957.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,971.46
|
| Rate for Payer: PHP Medicaid |
$960.64
|
| 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 |
$2,091.87
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,673.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,100.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$2,777.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP DNSP |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,387.44
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,551.84 |
| Max. Negotiated Rate |
$2,387.44 |
| Rate for Payer: Aetna Commercial |
$2,148.70
|
| Rate for Payer: ASR ASR |
$2,315.82
|
| Rate for Payer: ASR Commercial |
$2,315.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,945.52
|
| Rate for Payer: BCN Commercial |
$1,850.98
|
| Rate for Payer: Cash Price |
$1,909.95
|
| Rate for Payer: Cofinity Commercial |
$2,244.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,909.95
|
| Rate for Payer: Healthscope Commercial |
$2,387.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,315.82
|
| Rate for Payer: Mclaren Commercial |
$2,148.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,029.32
|
| Rate for Payer: Nomi Health Commercial |
$1,957.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,551.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,100.95
|
|
|
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 |
$370.96 |
| Max. Negotiated Rate |
$927.39 |
| Rate for Payer: Aetna Commercial |
$834.65
|
| Rate for Payer: Aetna Medicare |
$463.70
|
| Rate for Payer: ASR ASR |
$899.57
|
| Rate for Payer: ASR Commercial |
$899.57
|
| Rate for Payer: BCBS Complete |
$370.96
|
| Rate for Payer: BCBS Trust/PPO |
$759.44
|
| Rate for Payer: BCN Commercial |
$719.01
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$871.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Healthscope Commercial |
$927.39
|
| Rate for Payer: Healthscope Whirlpool |
$899.57
|
| Rate for Payer: Mclaren Commercial |
$834.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$812.58
|
| Rate for Payer: Priority Health Narrow Network |
$650.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$816.10
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$927.39 |
| Rate for Payer: Aetna Commercial |
$834.65
|
| Rate for Payer: ASR ASR |
$899.57
|
| Rate for Payer: ASR Commercial |
$899.57
|
| Rate for Payer: BCBS Trust/PPO |
$755.73
|
| Rate for Payer: BCN Commercial |
$719.01
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$871.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Healthscope Commercial |
$927.39
|
| Rate for Payer: Healthscope Whirlpool |
$899.57
|
| Rate for Payer: Mclaren Commercial |
$834.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$816.10
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$927.39 |
| Rate for Payer: Aetna Commercial |
$834.65
|
| Rate for Payer: ASR ASR |
$899.57
|
| Rate for Payer: ASR Commercial |
$899.57
|
| Rate for Payer: BCBS Trust/PPO |
$755.73
|
| Rate for Payer: BCN Commercial |
$719.01
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$871.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Healthscope Commercial |
$927.39
|
| Rate for Payer: Healthscope Whirlpool |
$899.57
|
| Rate for Payer: Mclaren Commercial |
$834.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$816.10
|
|
|
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 |
$370.96 |
| Max. Negotiated Rate |
$927.39 |
| Rate for Payer: Aetna Commercial |
$834.65
|
| Rate for Payer: Aetna Medicare |
$463.70
|
| Rate for Payer: ASR ASR |
$899.57
|
| Rate for Payer: ASR Commercial |
$899.57
|
| Rate for Payer: BCBS Complete |
$370.96
|
| Rate for Payer: BCBS Trust/PPO |
$759.44
|
| Rate for Payer: BCN Commercial |
$719.01
|
| Rate for Payer: Cash Price |
$741.91
|
| Rate for Payer: Cofinity Commercial |
$871.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.91
|
| Rate for Payer: Healthscope Commercial |
$927.39
|
| Rate for Payer: Healthscope Whirlpool |
$899.57
|
| Rate for Payer: Mclaren Commercial |
$834.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.28
|
| Rate for Payer: Nomi Health Commercial |
$760.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$812.58
|
| Rate for Payer: Priority Health Narrow Network |
$650.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$816.10
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.88 |
| Max. Negotiated Rate |
$710.59 |
| Rate for Payer: Aetna Commercial |
$639.53
|
| Rate for Payer: ASR ASR |
$689.27
|
| Rate for Payer: ASR Commercial |
$689.27
|
| Rate for Payer: BCBS Trust/PPO |
$579.06
|
| Rate for Payer: BCN Commercial |
$550.92
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$667.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$710.59
|
| Rate for Payer: Healthscope Whirlpool |
$689.27
|
| Rate for Payer: Mclaren Commercial |
$639.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.32
|
|
|
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 |
$284.24 |
| Max. Negotiated Rate |
$710.59 |
| Rate for Payer: Aetna Commercial |
$639.53
|
| Rate for Payer: Aetna Medicare |
$355.30
|
| Rate for Payer: ASR ASR |
$689.27
|
| Rate for Payer: ASR Commercial |
$689.27
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS Trust/PPO |
$581.90
|
| Rate for Payer: BCN Commercial |
$550.92
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$667.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$710.59
|
| Rate for Payer: Healthscope Whirlpool |
$689.27
|
| Rate for Payer: Mclaren Commercial |
$639.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$622.62
|
| Rate for Payer: Priority Health Narrow Network |
$498.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.32
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$710.59 |
| Rate for Payer: Aetna Commercial |
$639.53
|
| Rate for Payer: Aetna Medicare |
$355.30
|
| Rate for Payer: ASR ASR |
$689.27
|
| Rate for Payer: ASR Commercial |
$689.27
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS Trust/PPO |
$581.90
|
| Rate for Payer: BCN Commercial |
$550.92
|
| Rate for Payer: Cash Price |
$568.47
|
| Rate for Payer: Cofinity Commercial |
$667.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$568.47
|
| Rate for Payer: Healthscope Commercial |
$710.59
|
| Rate for Payer: Healthscope Whirlpool |
$689.27
|
| Rate for Payer: Mclaren Commercial |
$639.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.00
|
| Rate for Payer: Nomi Health Commercial |
$582.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$622.62
|
| Rate for Payer: Priority Health Narrow Network |
$498.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$625.32
|
|
