|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,340.63
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,638.44 |
| Max. Negotiated Rate |
$2,340.63 |
| Rate for Payer: Aetna Commercial |
$2,106.57
|
| Rate for Payer: ASR ASR |
$2,270.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.69
|
| Rate for Payer: BCN Commercial |
$1,814.69
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cofinity Commercial |
$2,200.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,872.50
|
| Rate for Payer: Healthscope Commercial |
$2,340.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,270.41
|
| Rate for Payer: Mclaren Commercial |
$2,106.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,989.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,059.75
|
|
|
HC APPLY HC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,340.63
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
76100057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,340.63 |
| Rate for Payer: Aetna Commercial |
$2,106.57
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$2,270.41
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.69
|
| Rate for Payer: BCN Commercial |
$1,814.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cofinity Commercial |
$2,200.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,872.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$2,340.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,270.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$2,106.57
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,989.54
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,129.97
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,661.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,059.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$909.21
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.45 |
| Max. Negotiated Rate |
$909.21 |
| Rate for Payer: Aetna Commercial |
$818.29
|
| Rate for Payer: ASR ASR |
$881.93
|
| Rate for Payer: BCBS Trust/PPO |
$704.91
|
| Rate for Payer: BCN Commercial |
$704.91
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.37
|
| Rate for Payer: Healthscope Commercial |
$909.21
|
| Rate for Payer: Healthscope Whirlpool |
$881.93
|
| Rate for Payer: Mclaren Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.10
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$909.21
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
76100064
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.68 |
| Max. Negotiated Rate |
$909.21 |
| Rate for Payer: Aetna Commercial |
$818.29
|
| Rate for Payer: ASR ASR |
$881.93
|
| Rate for Payer: BCBS Complete |
$363.68
|
| Rate for Payer: BCBS Trust/PPO |
$704.91
|
| Rate for Payer: BCN Commercial |
$704.91
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.37
|
| Rate for Payer: Healthscope Commercial |
$909.21
|
| Rate for Payer: Healthscope Whirlpool |
$881.93
|
| Rate for Payer: Mclaren Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.38
|
| Rate for Payer: Priority Health Narrow Network |
$645.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.10
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$909.21
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.45 |
| Max. Negotiated Rate |
$909.21 |
| Rate for Payer: Aetna Commercial |
$818.29
|
| Rate for Payer: ASR ASR |
$881.93
|
| Rate for Payer: BCBS Trust/PPO |
$704.91
|
| Rate for Payer: BCN Commercial |
$704.91
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.37
|
| Rate for Payer: Healthscope Commercial |
$909.21
|
| Rate for Payer: Healthscope Whirlpool |
$881.93
|
| Rate for Payer: Mclaren Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.10
|
|
|
HC APPLY HC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$909.21
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
76100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.68 |
| Max. Negotiated Rate |
$909.21 |
| Rate for Payer: Aetna Commercial |
$818.29
|
| Rate for Payer: ASR ASR |
$881.93
|
| Rate for Payer: BCBS Complete |
$363.68
|
| Rate for Payer: BCBS Trust/PPO |
$704.91
|
| Rate for Payer: BCN Commercial |
$704.91
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.37
|
| Rate for Payer: Healthscope Commercial |
$909.21
|
| Rate for Payer: Healthscope Whirlpool |
$881.93
|
| Rate for Payer: Mclaren Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.38
|
| Rate for Payer: Priority Health Narrow Network |
$645.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.10
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.66 |
| Max. Negotiated Rate |
$696.66 |
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.96
|
| Rate for Payer: Priority Health Narrow Network |
$494.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$696.66
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
76100062
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.66 |
| Max. Negotiated Rate |
$696.66 |
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$696.66
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.66 |
| Max. Negotiated Rate |
$696.66 |
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
|
HC APPLY HC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
76100058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.66 |
| Max. Negotiated Rate |
$696.66 |
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.96
|
| Rate for Payer: Priority Health Narrow Network |
$494.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$1,909.32
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,336.52 |
| Max. Negotiated Rate |
$1,909.32 |
| Rate for Payer: Aetna Commercial |
$1,718.39
|
| Rate for Payer: ASR ASR |
$1,852.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,480.30
|
| Rate for Payer: BCN Commercial |
$1,480.30
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cofinity Commercial |
$1,794.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.46
|
| Rate for Payer: Healthscope Commercial |
$1,909.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,852.04
|
| Rate for Payer: Mclaren Commercial |
$1,718.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,622.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,680.20
|
|
|
HC APPLY LC SKIN SUB 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$1,909.32
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,026.22 |
| Rate for Payer: Aetna Commercial |
$1,718.39
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$1,852.04
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,480.30
|
| Rate for Payer: BCN Commercial |
$1,480.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cash Price |
$1,527.46
|
| Rate for Payer: Cofinity Commercial |
$1,794.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$1,909.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,852.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$1,718.39
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,622.92
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,336.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,737.48
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,355.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,680.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,520.30
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,744.36 |
| Max. Negotiated Rate |
$3,986.20 |
| Rate for Payer: Aetna Commercial |
$2,268.27
|
| Rate for Payer: Aetna Medicare |
$3,188.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,986.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,986.20
|
| Rate for Payer: ASR ASR |
$2,444.69
|
| Rate for Payer: BCBS Complete |
$1,831.74
|
| Rate for Payer: BCBS MAPPO |
$3,188.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.99
|
| Rate for Payer: BCN Commercial |
$1,953.99
|
| Rate for Payer: BCN Medicare Advantage |
$3,188.96
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$2,369.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,016.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,188.96
|
| Rate for Payer: Healthscope Commercial |
$2,520.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,444.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,188.96
|
| Rate for Payer: Mclaren Commercial |
$2,268.27
|
| Rate for Payer: Mclaren Medicaid |
$1,744.36
|
| Rate for Payer: Mclaren Medicare |
$3,188.96
|
| Rate for Payer: Meridian Medicaid |
$1,831.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,348.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,142.26
|
| Rate for Payer: PACE Medicare |
$3,029.51
|
| Rate for Payer: PACE SWMI |
$3,188.96
|
| Rate for Payer: PHP Commercial |
$3,507.86
|
| Rate for Payer: PHP Medicaid |
$1,744.36
|
| Rate for Payer: PHP Medicare Advantage |
$3,188.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,744.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,293.47
|
| Rate for Payer: Priority Health Medicare |
$3,188.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,789.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,217.86
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.63
|
| Rate for Payer: VA VA |
$3,188.96
|
|
|
HC APPLY LC SKIN SUB 1ST 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,520.30
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,764.21 |
| Max. Negotiated Rate |
$2,520.30 |
| Rate for Payer: Aetna Commercial |
$2,268.27
|
| Rate for Payer: ASR ASR |
$2,444.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.99
|
| Rate for Payer: BCN Commercial |
$1,953.99
|
| Rate for Payer: Cash Price |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$2,369.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,016.24
|
| Rate for Payer: Healthscope Commercial |
$2,520.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,444.69
|
| Rate for Payer: Mclaren Commercial |
$2,268.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,142.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,217.86
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$2,553.43
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,553.43 |
| Rate for Payer: Aetna Commercial |
$2,298.09
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$2,476.83
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.67
|
| Rate for Payer: BCN Commercial |
$1,979.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cofinity Commercial |
$2,400.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,042.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$2,553.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,476.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$2,298.09
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,170.42
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,787.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,323.62
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,812.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,247.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$2,553.43
|
|
|
Service Code
|
HCPCS 15275
|
| Hospital Charge Code |
76100053
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,787.40 |
| Max. Negotiated Rate |
$2,553.43 |
| Rate for Payer: Aetna Commercial |
$2,298.09
|
| Rate for Payer: ASR ASR |
$2,476.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.67
|
| Rate for Payer: BCN Commercial |
$1,979.67
|
| Rate for Payer: Cash Price |
$2,042.74
|
| Rate for Payer: Cofinity Commercial |
$2,400.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,042.74
|
| Rate for Payer: Healthscope Commercial |
$2,553.43
|
| Rate for Payer: Healthscope Whirlpool |
$2,476.83
|
| Rate for Payer: Mclaren Commercial |
$2,298.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,170.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,787.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,247.02
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$2,340.63
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,340.63 |
| Rate for Payer: Aetna Commercial |
$2,106.57
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$2,270.41
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.69
|
| Rate for Payer: BCN Commercial |
$1,814.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cofinity Commercial |
$2,200.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,872.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$2,340.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,270.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$2,106.57
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,989.54
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,129.97
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,661.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,059.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
HC APPLY LC SKIN SUB 1ST 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$2,340.63
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
76100049
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,638.44 |
| Max. Negotiated Rate |
$2,340.63 |
| Rate for Payer: Aetna Commercial |
$2,106.57
|
| Rate for Payer: ASR ASR |
$2,270.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.69
|
| Rate for Payer: BCN Commercial |
$1,814.69
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cofinity Commercial |
$2,200.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,872.50
|
| Rate for Payer: Healthscope Commercial |
$2,340.63
|
| Rate for Payer: Healthscope Whirlpool |
$2,270.41
|
| Rate for Payer: Mclaren Commercial |
$2,106.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,989.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,638.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,059.75
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$909.21
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.68 |
| Max. Negotiated Rate |
$909.21 |
| Rate for Payer: Aetna Commercial |
$818.29
|
| Rate for Payer: ASR ASR |
$881.93
|
| Rate for Payer: BCBS Complete |
$363.68
|
| Rate for Payer: BCBS Trust/PPO |
$704.91
|
| Rate for Payer: BCN Commercial |
$704.91
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.37
|
| Rate for Payer: Healthscope Commercial |
$909.21
|
| Rate for Payer: Healthscope Whirlpool |
$881.93
|
| Rate for Payer: Mclaren Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.38
|
| Rate for Payer: Priority Health Narrow Network |
$645.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.10
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$909.21
|
|
|
Service Code
|
HCPCS 15278
|
| Hospital Charge Code |
76100056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.45 |
| Max. Negotiated Rate |
$909.21 |
| Rate for Payer: Aetna Commercial |
$818.29
|
| Rate for Payer: ASR ASR |
$881.93
|
| Rate for Payer: BCBS Trust/PPO |
$704.91
|
| Rate for Payer: BCN Commercial |
$704.91
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.37
|
| Rate for Payer: Healthscope Commercial |
$909.21
|
| Rate for Payer: Healthscope Whirlpool |
$881.93
|
| Rate for Payer: Mclaren Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.10
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$909.21
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.68 |
| Max. Negotiated Rate |
$909.21 |
| Rate for Payer: Aetna Commercial |
$818.29
|
| Rate for Payer: ASR ASR |
$881.93
|
| Rate for Payer: BCBS Complete |
$363.68
|
| Rate for Payer: BCBS Trust/PPO |
$704.91
|
| Rate for Payer: BCN Commercial |
$704.91
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.37
|
| Rate for Payer: Healthscope Commercial |
$909.21
|
| Rate for Payer: Healthscope Whirlpool |
$881.93
|
| Rate for Payer: Mclaren Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.38
|
| Rate for Payer: Priority Health Narrow Network |
$645.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.10
|
|
|
HC APPLY LC SKIN SUB ADDL 100 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
IP
|
$909.21
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
76100052
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$636.45 |
| Max. Negotiated Rate |
$909.21 |
| Rate for Payer: Aetna Commercial |
$818.29
|
| Rate for Payer: ASR ASR |
$881.93
|
| Rate for Payer: BCBS Trust/PPO |
$704.91
|
| Rate for Payer: BCN Commercial |
$704.91
|
| Rate for Payer: Cash Price |
$727.37
|
| Rate for Payer: Cofinity Commercial |
$854.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.37
|
| Rate for Payer: Healthscope Commercial |
$909.21
|
| Rate for Payer: Healthscope Whirlpool |
$881.93
|
| Rate for Payer: Mclaren Commercial |
$818.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$772.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.10
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.66 |
| Max. Negotiated Rate |
$696.66 |
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.96
|
| Rate for Payer: Priority Health Narrow Network |
$494.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO HEAD, HANDS, FEET
|
Facility
|
IP
|
$696.66
|
|
|
Service Code
|
HCPCS 15276
|
| Hospital Charge Code |
76100054
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.66 |
| Max. Negotiated Rate |
$696.66 |
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
|
HC APPLY LC SKIN SUB ADDL 25 SQ CM TO TRUNK, ARMS, LEGS
|
Facility
|
OP
|
$696.66
|
|
|
Service Code
|
HCPCS 15272
|
| Hospital Charge Code |
76100050
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.66 |
| Max. Negotiated Rate |
$696.66 |
| Rate for Payer: Aetna Commercial |
$626.99
|
| Rate for Payer: ASR ASR |
$675.76
|
| Rate for Payer: BCBS Complete |
$278.66
|
| Rate for Payer: BCBS Trust/PPO |
$540.12
|
| Rate for Payer: BCN Commercial |
$540.12
|
| Rate for Payer: Cash Price |
$557.33
|
| Rate for Payer: Cofinity Commercial |
$654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.33
|
| Rate for Payer: Healthscope Commercial |
$696.66
|
| Rate for Payer: Healthscope Whirlpool |
$675.76
|
| Rate for Payer: Mclaren Commercial |
$626.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$592.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.96
|
| Rate for Payer: Priority Health Narrow Network |
$494.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$613.06
|
|
