|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,145.90
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,241.92 |
| Max. Negotiated Rate |
$4,631.31 |
| Rate for Payer: Aetna Commercial |
$4,374.02
|
| Rate for Payer: Aetna Commercial |
$7,532.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,760.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,344.84
|
| Rate for Payer: Cash Price |
$4,116.72
|
| Rate for Payer: Cash Price |
$7,089.60
|
| Rate for Payer: Cofinity Commercial |
$6,203.40
|
| Rate for Payer: Cofinity Commercial |
$3,602.13
|
| Rate for Payer: Cofinity Commercial |
$4,425.47
|
| Rate for Payer: Cofinity Commercial |
$7,621.32
|
| Rate for Payer: Healthscope Commercial |
$4,631.31
|
| Rate for Payer: Healthscope Commercial |
$7,975.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,532.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,374.02
|
| Rate for Payer: PHP Commercial |
$4,374.02
|
| Rate for Payer: PHP Commercial |
$7,532.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,602.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,203.40
|
| Rate for Payer: Priority Health SBD |
$5,583.06
|
| Rate for Payer: Priority Health SBD |
$3,241.92
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$8,862.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$432.98 |
| Max. Negotiated Rate |
$7,975.80 |
| Rate for Payer: Aetna Commercial |
$7,532.70
|
| Rate for Payer: Aetna Commercial |
$4,374.02
|
| Rate for Payer: Aetna Medicare |
$1,282.24
|
| Rate for Payer: Aetna Medicare |
$1,282.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,344.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,760.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,541.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,541.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,541.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,541.15
|
| Rate for Payer: BCBS Complete |
$708.19
|
| Rate for Payer: BCBS Complete |
$708.19
|
| Rate for Payer: BCBS MAPPO |
$1,232.92
|
| Rate for Payer: BCBS MAPPO |
$1,232.92
|
| Rate for Payer: BCBS Trust/PPO |
$432.98
|
| Rate for Payer: BCBS Trust/PPO |
$432.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,232.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,232.92
|
| Rate for Payer: Cash Price |
$7,089.60
|
| Rate for Payer: Cash Price |
$7,089.60
|
| Rate for Payer: Cash Price |
$4,116.72
|
| Rate for Payer: Cash Price |
$4,116.72
|
| Rate for Payer: Cofinity Commercial |
$7,621.32
|
| Rate for Payer: Cofinity Commercial |
$6,203.40
|
| Rate for Payer: Cofinity Commercial |
$4,425.47
|
| Rate for Payer: Cofinity Commercial |
$3,602.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,232.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,232.92
|
| Rate for Payer: Healthscope Commercial |
$4,631.31
|
| Rate for Payer: Healthscope Commercial |
$7,975.80
|
| Rate for Payer: Mclaren Medicaid |
$674.41
|
| Rate for Payer: Mclaren Medicaid |
$674.41
|
| Rate for Payer: Mclaren Medicare |
$1,232.92
|
| Rate for Payer: Mclaren Medicare |
$1,232.92
|
| Rate for Payer: Meridian Medicaid |
$708.19
|
| Rate for Payer: Meridian Medicaid |
$708.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,294.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,294.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,417.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,417.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,532.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,374.02
|
| Rate for Payer: PACE Medicare |
$1,171.27
|
| Rate for Payer: PACE Medicare |
$1,171.27
|
| Rate for Payer: PACE SWMI |
$1,232.92
|
| Rate for Payer: PACE SWMI |
$1,232.92
|
| Rate for Payer: PHP Commercial |
$7,532.70
|
| Rate for Payer: PHP Commercial |
$4,374.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,232.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,232.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,602.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,203.40
|
| Rate for Payer: Priority Health Medicare |
$1,232.92
|
| Rate for Payer: Priority Health Medicare |
$1,232.92
|
| Rate for Payer: Priority Health SBD |
$3,241.92
|
| Rate for Payer: Priority Health SBD |
$5,583.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,232.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,232.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,232.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,232.92
|
| Rate for Payer: UHC Exchange |
$472.17
|
| Rate for Payer: UHC Exchange |
$472.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.91
|
| Rate for Payer: VA VA |
$1,232.92
|
| Rate for Payer: VA VA |
$1,232.92
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$3,061.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,928.43 |
| Max. Negotiated Rate |
$2,754.90 |
| Rate for Payer: Aetna Commercial |
$2,601.85
|
| Rate for Payer: Aetna Commercial |
$1,422.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,087.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,989.65
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cofinity Commercial |
$2,142.70
|
| Rate for Payer: Cofinity Commercial |
$1,171.67
|
| Rate for Payer: Cofinity Commercial |
$1,439.49
|
| Rate for Payer: Cofinity Commercial |
$2,632.46
|
| Rate for Payer: Healthscope Commercial |
$1,506.44
|
| Rate for Payer: Healthscope Commercial |
$2,754.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,422.75
|
| Rate for Payer: PHP Commercial |
$2,601.85
|
| Rate for Payer: PHP Commercial |
$1,422.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.70
|
| Rate for Payer: Priority Health SBD |
$1,054.51
|
| Rate for Payer: Priority Health SBD |
$1,928.43
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$3,061.00
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$2,754.90 |
| Rate for Payer: Aetna Commercial |
$2,601.85
|
| Rate for Payer: Aetna Commercial |
$1,422.75
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,087.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,989.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$611.72
|
| Rate for Payer: BCBS Trust/PPO |
$611.72
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cofinity Commercial |
$2,142.70
|
| Rate for Payer: Cofinity Commercial |
$1,171.67
|
| Rate for Payer: Cofinity Commercial |
$1,439.49
|
| Rate for Payer: Cofinity Commercial |
$2,632.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$1,506.44
|
| Rate for Payer: Healthscope Commercial |
$2,754.90
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,422.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.85
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$2,601.85
|
| Rate for Payer: PHP Commercial |
$1,422.75
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.70
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$1,928.43
|
| Rate for Payer: Priority Health SBD |
$1,054.51
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$439.75
|
| Rate for Payer: UHC Exchange |
$439.75
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$2,642.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.84 |
| Max. Negotiated Rate |
$2,377.80 |
| Rate for Payer: Aetna Commercial |
$2,245.70
|
| Rate for Payer: Aetna Commercial |
$994.50
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna Medicare |
$341.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,717.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.96
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS Complete |
$188.85
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$328.77
|
| Rate for Payer: BCBS Trust/PPO |
$635.44
|
| Rate for Payer: BCBS Trust/PPO |
$635.44
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: BCN Medicare Advantage |
$328.77
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$2,272.12
|
| Rate for Payer: Cofinity Commercial |
$1,006.20
|
| Rate for Payer: Cofinity Commercial |
$819.00
|
| Rate for Payer: Cofinity Commercial |
$1,849.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.77
|
| Rate for Payer: Healthscope Commercial |
$1,053.00
|
| Rate for Payer: Healthscope Commercial |
$2,377.80
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicaid |
$179.84
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Mclaren Medicare |
$328.77
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Medicaid |
$188.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,245.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.50
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE Medicare |
$312.33
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PACE SWMI |
$328.77
|
| Rate for Payer: PHP Commercial |
$994.50
|
| Rate for Payer: PHP Commercial |
$2,245.70
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.40
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health SBD |
$1,664.46
|
| Rate for Payer: Priority Health SBD |
$737.10
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: Railroad Medicare Medicare |
$328.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.77
|
| Rate for Payer: UHC Exchange |
$433.21
|
| Rate for Payer: UHC Exchange |
$433.21
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: UHC Medicare Advantage |
$338.63
|
| Rate for Payer: VA VA |
$328.77
|
| Rate for Payer: VA VA |
$328.77
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$2,642.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,664.46 |
| Max. Negotiated Rate |
$2,377.80 |
| Rate for Payer: Aetna Commercial |
$2,245.70
|
| Rate for Payer: Aetna Commercial |
$994.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,717.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.50
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$2,272.12
|
| Rate for Payer: Cofinity Commercial |
$1,006.20
|
| Rate for Payer: Cofinity Commercial |
$819.00
|
| Rate for Payer: Cofinity Commercial |
$1,849.40
|
| Rate for Payer: Healthscope Commercial |
$1,053.00
|
| Rate for Payer: Healthscope Commercial |
$2,377.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,245.70
|
| Rate for Payer: PHP Commercial |
$2,245.70
|
| Rate for Payer: PHP Commercial |
$994.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.40
|
| Rate for Payer: Priority Health SBD |
$737.10
|
| Rate for Payer: Priority Health SBD |
$1,664.46
|
|
|
HC SIMULATION - S
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna Commercial |
$1,352.35
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS Trust/PPO |
$382.81
|
| Rate for Payer: BCBS Trust/PPO |
$382.81
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Cofinity Commercial |
$1,368.26
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| Rate for Payer: Cofinity Commercial |
$499.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Healthscope Commercial |
$1,431.90
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$606.90
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: PHP Commercial |
$1,352.35
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health SBD |
$449.82
|
| Rate for Payer: Priority Health SBD |
$1,002.33
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Exchange |
$264.57
|
| Rate for Payer: UHC Exchange |
$264.57
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: VA VA |
$120.73
|
| Rate for Payer: VA VA |
$120.73
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,002.33 |
| Max. Negotiated Rate |
$1,431.90 |
| Rate for Payer: Aetna Commercial |
$1,352.35
|
| Rate for Payer: Aetna Commercial |
$606.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.15
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$499.80
|
| Rate for Payer: Cofinity Commercial |
$1,113.70
|
| Rate for Payer: Cofinity Commercial |
$1,368.26
|
| Rate for Payer: Cofinity Commercial |
$614.04
|
| Rate for Payer: Healthscope Commercial |
$1,431.90
|
| Rate for Payer: Healthscope Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$606.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,352.35
|
| Rate for Payer: PHP Commercial |
$1,352.35
|
| Rate for Payer: PHP Commercial |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health SBD |
$449.82
|
| Rate for Payer: Priority Health SBD |
$1,002.33
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,255.75
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,681.12 |
| Max. Negotiated Rate |
$3,830.18 |
| Rate for Payer: Aetna Commercial |
$3,617.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,766.24
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cofinity Commercial |
$2,979.02
|
| Rate for Payer: Cofinity Commercial |
$3,659.94
|
| Rate for Payer: Healthscope Commercial |
$3,830.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,617.39
|
| Rate for Payer: PHP Commercial |
$3,617.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,979.02
|
| Rate for Payer: Priority Health SBD |
$2,681.12
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,255.75
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$359.53 |
| Max. Negotiated Rate |
$25,402.85 |
| Rate for Payer: Aetna Commercial |
$3,617.39
|
| Rate for Payer: Aetna Medicare |
$7,861.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,766.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,449.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,449.24
|
| Rate for Payer: BCBS Complete |
$4,342.11
|
| Rate for Payer: BCBS MAPPO |
$7,559.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,183.83
|
| Rate for Payer: BCN Medicare Advantage |
$7,559.39
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cofinity Commercial |
$2,979.02
|
| Rate for Payer: Cofinity Commercial |
$3,659.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,559.39
|
| Rate for Payer: Healthscope Commercial |
$3,830.18
|
| Rate for Payer: Mclaren Medicaid |
$4,134.99
|
| Rate for Payer: Mclaren Medicare |
$7,559.39
|
| Rate for Payer: Meridian Medicaid |
$4,342.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,937.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,693.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,617.39
|
| Rate for Payer: PACE Medicare |
$7,181.42
|
| Rate for Payer: PACE SWMI |
$7,559.39
|
| Rate for Payer: PHP Commercial |
$3,617.39
|
| Rate for Payer: PHP Medicare Advantage |
$7,559.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,134.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,979.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,402.85
|
| Rate for Payer: Priority Health Medicare |
$7,559.39
|
| Rate for Payer: Priority Health Narrow Network |
$20,322.28
|
| Rate for Payer: Priority Health SBD |
$2,681.12
|
| Rate for Payer: Railroad Medicare Medicare |
$7,559.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.48
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,559.39
|
| Rate for Payer: UHC Exchange |
$359.53
|
| Rate for Payer: UHC Medicare Advantage |
$7,786.17
|
| Rate for Payer: VA VA |
$7,559.39
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$443.15
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$376.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.05
|
| Rate for Payer: BCBS Complete |
$177.26
|
| Rate for Payer: BCBS Trust/PPO |
$235.89
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cofinity Commercial |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$381.11
|
| Rate for Payer: Healthscope Commercial |
$398.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.68
|
| Rate for Payer: PHP Commercial |
$376.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.20
|
| Rate for Payer: Priority Health SBD |
$279.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.54
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$35.04
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$443.15
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.18 |
| Max. Negotiated Rate |
$398.84 |
| Rate for Payer: Aetna Commercial |
$376.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.05
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cofinity Commercial |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$381.11
|
| Rate for Payer: Healthscope Commercial |
$398.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.68
|
| Rate for Payer: PHP Commercial |
$376.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.20
|
| Rate for Payer: Priority Health SBD |
$279.18
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$74.46
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Aetna Commercial |
$63.29
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Cofinity Commercial |
$52.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$67.01
|
| Rate for Payer: Mclaren Medicaid |
$7.51
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$63.29
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health SBD |
$46.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.48
|
| Rate for Payer: UHC Core |
$23.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$13.73
|
| Rate for Payer: UHC Medicare Advantage |
$14.14
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$74.46
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Aetna Commercial |
$63.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.40
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$52.12
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Healthscope Commercial |
$67.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PHP Commercial |
$63.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health SBD |
$46.91
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.24 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Commercial |
$4,250.00
|
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,250.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,662.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$4,300.00
|
| Rate for Payer: Cofinity Commercial |
$3,500.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Healthscope Commercial |
$4,500.00
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,250.00
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Commercial |
$4,250.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,500.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Priority Health SBD |
$3,150.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$861.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$783.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,150.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$4,250.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,250.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$3,500.00
|
| Rate for Payer: Cofinity Commercial |
$4,300.00
|
| Rate for Payer: Healthscope Commercial |
$4,500.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,250.00
|
| Rate for Payer: PHP Commercial |
$4,250.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,500.00
|
| Rate for Payer: Priority Health SBD |
$3,150.00
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
OP
|
$267.34
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.64 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$81.34
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$187.14
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$168.42
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$75.64
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
IP
|
$267.34
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.42 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.77
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$187.14
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health SBD |
$168.42
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
IP
|
$18.36
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health SBD |
$11.57
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$38.02 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$38.02
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Exchange |
$15.72
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
IP
|
$2,710.48
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$2,439.43 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.81
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$1,897.34
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health SBD |
$1,707.60
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
OP
|
$2,710.48
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.51 |
| Max. Negotiated Rate |
$5,561.92 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$831.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Cofinity Commercial |
$1,897.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,561.92
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,449.54
|
| Rate for Payer: Priority Health SBD |
$1,707.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$138.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC SMART NEEDLE
|
Facility
|
IP
|
$490.51
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.83
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health SBD |
$309.02
|
|
|
HC SMART NEEDLE
|
Facility
|
OP
|
$490.51
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.83
|
| Rate for Payer: BCBS Complete |
$196.20
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health SBD |
$309.02
|
|
|
HC SMITH SM ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
