|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.88 |
| Max. Negotiated Rate |
$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 LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,947.51
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,265.88 |
| Max. Negotiated Rate |
$1,947.51 |
| 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 LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,947.51
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$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 LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,570.71
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$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 LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,570.71
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,670.96 |
| Max. Negotiated Rate |
$2,570.71 |
| 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 LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,604.50
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,692.92 |
| 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 LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,604.50
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$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 LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,387.44
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
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 LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,387.44
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
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 LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
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 LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$927.39
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
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 LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$927.39
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
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 LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$927.39
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
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 LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
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 LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
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 LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$710.59
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
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 LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$710.59
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
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 SPLINT/CAST COMPLEX
|
Facility
|
OP
|
$328.86
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.54 |
| Max. Negotiated Rate |
$328.86 |
| Rate for Payer: Aetna Commercial |
$295.97
|
| Rate for Payer: Aetna Medicare |
$164.43
|
| Rate for Payer: ASR ASR |
$318.99
|
| Rate for Payer: ASR Commercial |
$318.99
|
| Rate for Payer: BCBS Complete |
$131.54
|
| Rate for Payer: BCBS Trust/PPO |
$269.30
|
| Rate for Payer: BCN Commercial |
$254.97
|
| Rate for Payer: Cash Price |
$263.09
|
| Rate for Payer: Cofinity Commercial |
$309.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.09
|
| Rate for Payer: Healthscope Commercial |
$328.86
|
| Rate for Payer: Healthscope Whirlpool |
$318.99
|
| Rate for Payer: Mclaren Commercial |
$295.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.53
|
| Rate for Payer: Nomi Health Commercial |
$269.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.15
|
| Rate for Payer: Priority Health Narrow Network |
$230.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.40
|
|
|
HC APPLY SPLINT/CAST COMPLEX
|
Facility
|
IP
|
$328.86
|
|
| Hospital Charge Code |
45000027
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.76 |
| Max. Negotiated Rate |
$328.86 |
| Rate for Payer: Aetna Commercial |
$295.97
|
| Rate for Payer: ASR ASR |
$318.99
|
| Rate for Payer: ASR Commercial |
$318.99
|
| Rate for Payer: BCBS Trust/PPO |
$267.99
|
| Rate for Payer: BCN Commercial |
$254.97
|
| Rate for Payer: Cash Price |
$263.09
|
| Rate for Payer: Cofinity Commercial |
$309.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.09
|
| Rate for Payer: Healthscope Commercial |
$328.86
|
| Rate for Payer: Healthscope Whirlpool |
$318.99
|
| Rate for Payer: Mclaren Commercial |
$295.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.53
|
| Rate for Payer: Nomi Health Commercial |
$269.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.40
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
IP
|
$197.01
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.06 |
| Max. Negotiated Rate |
$197.01 |
| Rate for Payer: Aetna Commercial |
$177.31
|
| Rate for Payer: ASR ASR |
$191.10
|
| Rate for Payer: ASR Commercial |
$191.10
|
| Rate for Payer: BCBS Trust/PPO |
$160.54
|
| Rate for Payer: BCN Commercial |
$152.74
|
| Rate for Payer: Cash Price |
$157.61
|
| Rate for Payer: Cofinity Commercial |
$185.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.61
|
| Rate for Payer: Healthscope Commercial |
$197.01
|
| Rate for Payer: Healthscope Whirlpool |
$191.10
|
| Rate for Payer: Mclaren Commercial |
$177.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.46
|
| Rate for Payer: Nomi Health Commercial |
$161.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.37
|
|
|
HC APPLY SPLINT/CAST SIMPLE
|
Facility
|
OP
|
$197.01
|
|
| Hospital Charge Code |
45000028
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$197.01 |
| Rate for Payer: Aetna Commercial |
$177.31
|
| Rate for Payer: Aetna Medicare |
$98.50
|
| Rate for Payer: ASR ASR |
$191.10
|
| Rate for Payer: ASR Commercial |
$191.10
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS Trust/PPO |
$161.33
|
| Rate for Payer: BCN Commercial |
$152.74
|
| Rate for Payer: Cash Price |
$157.61
|
| Rate for Payer: Cofinity Commercial |
$185.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.61
|
| Rate for Payer: Healthscope Commercial |
$197.01
|
| Rate for Payer: Healthscope Whirlpool |
$191.10
|
| Rate for Payer: Mclaren Commercial |
$177.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.46
|
| Rate for Payer: Nomi Health Commercial |
$161.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.62
|
| Rate for Payer: Priority Health Narrow Network |
$138.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.37
|
|
|
HC APT DOWNEY TEST
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.00
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: ASR Commercial |
$89.44
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$75.51
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: BCN Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.00
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$4.29
|
| Rate for Payer: Mclaren Medicare |
$8.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.40
|
| Rate for Payer: Meridian Medicaid |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PACE Medicare |
$7.60
|
| Rate for Payer: PACE SWMI |
$8.00
|
| Rate for Payer: PHP Commercial |
$8.80
|
| Rate for Payer: PHP Medicaid |
$4.29
|
| Rate for Payer: PHP Medicare Advantage |
$8.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.79
|
| Rate for Payer: Priority Health Medicare |
$8.00
|
| Rate for Payer: Priority Health Narrow Network |
$64.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.00
|
| Rate for Payer: UHC Exchange |
$12.40
|
| Rate for Payer: UHC Medicare Advantage |
$8.00
|
| Rate for Payer: UHCCP DNSP |
$8.00
|
| Rate for Payer: UHCCP Medicaid |
$4.29
|
| Rate for Payer: VA VA |
$8.00
|
|
|
HC APT DOWNEY TEST
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 83033
|
| Hospital Charge Code |
30100237
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$92.21 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: ASR ASR |
$89.44
|
| Rate for Payer: ASR Commercial |
$89.44
|
| Rate for Payer: BCBS Trust/PPO |
$75.14
|
| Rate for Payer: BCN Commercial |
$71.49
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$86.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$92.21
|
| Rate for Payer: Healthscope Whirlpool |
$89.44
|
| Rate for Payer: Mclaren Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.14
|
|
|
HC APTT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.30
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.01
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$3.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$6.61
|
| Rate for Payer: PHP Medicaid |
$3.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.33
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health Narrow Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.01
|
| Rate for Payer: UHC Exchange |
$9.32
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHCCP DNSP |
$6.01
|
| Rate for Payer: UHCCP Medicaid |
$3.22
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC APTT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$26.01 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: ASR ASR |
$25.23
|
| Rate for Payer: ASR Commercial |
$25.23
|
| Rate for Payer: BCBS Trust/PPO |
$21.20
|
| Rate for Payer: BCN Commercial |
$20.17
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$24.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$26.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.89
|
|
