|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
OP
|
$573.24
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$487.25
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$142.79
|
| Rate for Payer: BCN Commercial |
$142.79
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Advantage |
$401.27
|
| Rate for Payer: Cofinity Commercial |
$492.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$515.92
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.25
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.93
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$487.25
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$361.14
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.61
|
| Rate for Payer: UHC Core |
$298.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$225.28
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
IP
|
$573.24
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.14 |
| Max. Negotiated Rate |
$515.92 |
| Rate for Payer: Aetna Commercial |
$487.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.61
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Advantage |
$401.27
|
| Rate for Payer: Cofinity Commercial |
$492.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Healthscope Commercial |
$515.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.93
|
| Rate for Payer: PHP Commercial |
$487.25
|
| Rate for Payer: Priority Health SBD |
$361.14
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
OP
|
$650.76
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$553.15
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$253.49
|
| Rate for Payer: BCN Commercial |
$253.49
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cofinity Advantage |
$455.53
|
| Rate for Payer: Cofinity Commercial |
$559.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$585.68
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.15
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.07
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$553.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$409.98
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.99
|
| Rate for Payer: UHC Core |
$339.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$255.75
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
IP
|
$650.76
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.98 |
| Max. Negotiated Rate |
$585.68 |
| Rate for Payer: Aetna Commercial |
$553.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.99
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cofinity Advantage |
$455.53
|
| Rate for Payer: Cofinity Commercial |
$559.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.61
|
| Rate for Payer: Healthscope Commercial |
$585.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.07
|
| Rate for Payer: PHP Commercial |
$553.15
|
| Rate for Payer: Priority Health SBD |
$409.98
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$278.14
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$105.41
|
| Rate for Payer: BCN Commercial |
$105.41
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Advantage |
$194.70
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$175.23
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.79
|
| Rate for Payer: UHC Core |
$144.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$109.31
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$278.14
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.23 |
| Max. Negotiated Rate |
$250.33 |
| Rate for Payer: Aetna Commercial |
$236.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.79
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Advantage |
$194.70
|
| Rate for Payer: Cofinity Commercial |
$239.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Healthscope Commercial |
$250.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: PHP Commercial |
$236.42
|
| Rate for Payer: Priority Health SBD |
$175.23
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$150.05
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.97 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$123.90
|
| Rate for Payer: BCN Commercial |
$123.90
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Advantage |
$105.03
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$94.53
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.53
|
| Rate for Payer: UHC Core |
$78.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$58.97
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$150.05
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.53 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.53
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Advantage |
$105.03
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: Priority Health SBD |
$94.53
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$567.61
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$482.47
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$161.49
|
| Rate for Payer: BCN Commercial |
$161.49
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cofinity Advantage |
$397.33
|
| Rate for Payer: Cofinity Commercial |
$488.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$510.85
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.47
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.71
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$482.47
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$357.59
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.95
|
| Rate for Payer: UHC Core |
$295.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$223.07
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$567.61
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.59 |
| Max. Negotiated Rate |
$510.85 |
| Rate for Payer: Aetna Commercial |
$482.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.95
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cofinity Advantage |
$397.33
|
| Rate for Payer: Cofinity Commercial |
$488.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.09
|
| Rate for Payer: Healthscope Commercial |
$510.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.71
|
| Rate for Payer: PHP Commercial |
$482.47
|
| Rate for Payer: Priority Health SBD |
$357.59
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,353.80
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,372.89 |
| Max. Negotiated Rate |
$4,818.42 |
| Rate for Payer: Aetna Commercial |
$4,550.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.97
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cofinity Advantage |
$3,747.66
|
| Rate for Payer: Cofinity Commercial |
$4,604.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.04
|
| Rate for Payer: Healthscope Commercial |
$4,818.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.35
|
| Rate for Payer: PHP Commercial |
$4,550.73
|
| Rate for Payer: Priority Health SBD |
$3,372.89
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,353.80
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$589.52 |
| Max. Negotiated Rate |
$4,818.42 |
| Rate for Payer: Aetna Commercial |
$4,550.73
|
| Rate for Payer: Aetna Medicare |
$1,434.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,479.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,723.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,723.94
|
| Rate for Payer: BCBS Complete |
$757.43
|
| Rate for Payer: BCBS MAPPO |
$1,379.15
|
| Rate for Payer: BCBS Trust/PPO |
$589.52
|
| Rate for Payer: BCN Commercial |
$589.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.15
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cofinity Advantage |
$3,747.66
|
| Rate for Payer: Cofinity Commercial |
$4,604.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.15
|
| Rate for Payer: Healthscope Commercial |
$4,818.42
|
| Rate for Payer: Mclaren Medicaid |
$721.30
|
| Rate for Payer: Mclaren Medicare |
$1,379.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.11
|
| Rate for Payer: Meridian Medicaid |
$1,448.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,586.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,517.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.73
|
| Rate for Payer: Nomi Health Commercial |
$4,137.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.35
|
| Rate for Payer: PACE Medicare |
$1,310.19
|
| Rate for Payer: PACE SWMI |
$1,379.15
|
| Rate for Payer: PHP Commercial |
$4,550.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$721.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,460.05
|
| Rate for Payer: Priority Health Medicare |
$1,379.15
|
| Rate for Payer: Priority Health SBD |
$3,372.89
|
| Rate for Payer: Priority Health Tiered Network |
$3,568.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,379.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,479.97
|
| Rate for Payer: UHC Core |
$2,789.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,379.15
|
| Rate for Payer: UHC Exchange |
$2,104.04
|
| Rate for Payer: UHC Medicaid |
$721.30
|
| Rate for Payer: UHCCP Medicaid |
$721.30
|
| Rate for Payer: VA VA |
$1,379.15
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$1,741.45
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$1,567.31 |
| Rate for Payer: Aetna Commercial |
$1,480.23
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$813.17
|
| Rate for Payer: BCN Commercial |
$813.17
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cofinity Advantage |
$1,219.02
|
| Rate for Payer: Cofinity Commercial |
$1,497.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$1,567.31
|
| Rate for Payer: Mclaren Medicaid |
$195.12
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.23
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,306.09
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$1,480.23
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$1,097.11
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,131.94
|
| Rate for Payer: UHC Core |
$907.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$684.39
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$1,741.45
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,097.11 |
| Max. Negotiated Rate |
$1,567.31 |
| Rate for Payer: Aetna Commercial |
$1,480.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.94
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cofinity Advantage |
$1,219.02
|
| Rate for Payer: Cofinity Commercial |
$1,497.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.16
|
| Rate for Payer: Healthscope Commercial |
$1,567.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,306.09
|
| Rate for Payer: PHP Commercial |
$1,480.23
|
| Rate for Payer: Priority Health SBD |
$1,097.11
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$1,217.27
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$766.88 |
| Max. Negotiated Rate |
$1,095.54 |
| Rate for Payer: Aetna Commercial |
$1,034.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.23
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cofinity Advantage |
$852.09
|
| Rate for Payer: Cofinity Commercial |
$1,046.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.82
|
| Rate for Payer: Healthscope Commercial |
$1,095.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.95
|
| Rate for Payer: PHP Commercial |
$1,034.68
|
| Rate for Payer: Priority Health SBD |
$766.88
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$1,217.27
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$195.12 |
| Max. Negotiated Rate |
$1,206.50 |
| Rate for Payer: Aetna Commercial |
$1,034.68
|
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$881.32
|
| Rate for Payer: BCN Commercial |
$881.32
|
| Rate for Payer: BCN Medicare Advantage |
$373.08
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cofinity Advantage |
$852.09
|
| Rate for Payer: Cofinity Commercial |
$1,046.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.08
|
| Rate for Payer: Healthscope Commercial |
$1,095.54
|
| Rate for Payer: Mclaren Medicaid |
$195.12
|
| Rate for Payer: Mclaren Medicare |
$373.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.73
|
| Rate for Payer: Meridian Medicaid |
$391.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.68
|
| Rate for Payer: Nomi Health Commercial |
$1,119.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.95
|
| Rate for Payer: PACE Medicare |
$354.43
|
| Rate for Payer: PACE SWMI |
$373.08
|
| Rate for Payer: PHP Commercial |
$1,034.68
|
| Rate for Payer: PHP Medicare Advantage |
$373.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,206.50
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health SBD |
$766.88
|
| Rate for Payer: Priority Health Tiered Network |
$965.20
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$791.23
|
| Rate for Payer: UHC Core |
$634.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$478.39
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP Medicaid |
$195.12
|
| Rate for Payer: VA VA |
$373.08
|
|
|
HC SIMULATION - S
|
Facility
|
OP
|
$742.85
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$668.57 |
| Rate for Payer: Aetna Commercial |
$631.42
|
| Rate for Payer: Aetna Medicare |
$139.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$523.19
|
| Rate for Payer: BCN Commercial |
$523.19
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$594.28
|
| Rate for Payer: Cash Price |
$594.28
|
| Rate for Payer: Cofinity Advantage |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$638.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$668.57
|
| Rate for Payer: Mclaren Medicaid |
$70.05
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$140.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$631.42
|
| Rate for Payer: Nomi Health Commercial |
$401.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.14
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$631.42
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$433.11
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health SBD |
$468.00
|
| Rate for Payer: Priority Health Tiered Network |
$346.49
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$482.85
|
| Rate for Payer: UHC Core |
$387.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$291.94
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$742.85
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$668.57 |
| Rate for Payer: Aetna Commercial |
$631.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.85
|
| Rate for Payer: Cash Price |
$594.28
|
| Rate for Payer: Cofinity Advantage |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$638.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.28
|
| Rate for Payer: Healthscope Commercial |
$668.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$631.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.14
|
| Rate for Payer: PHP Commercial |
$631.42
|
| Rate for Payer: Priority Health SBD |
$468.00
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,427.69
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,789.44 |
| Max. Negotiated Rate |
$3,984.92 |
| Rate for Payer: Aetna Commercial |
$3,763.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,878.00
|
| Rate for Payer: Cash Price |
$3,542.15
|
| Rate for Payer: Cofinity Advantage |
$3,099.38
|
| Rate for Payer: Cofinity Commercial |
$3,807.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,542.15
|
| Rate for Payer: Healthscope Commercial |
$3,984.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,763.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,320.77
|
| Rate for Payer: PHP Commercial |
$3,763.54
|
| Rate for Payer: Priority Health SBD |
$2,789.44
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,427.69
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,789.44 |
| Max. Negotiated Rate |
$26,665.62 |
| Rate for Payer: Aetna Commercial |
$3,763.54
|
| Rate for Payer: Aetna Medicare |
$8,575.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,878.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,307.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,307.04
|
| Rate for Payer: BCBS Complete |
$4,528.50
|
| Rate for Payer: BCBS MAPPO |
$8,245.63
|
| Rate for Payer: BCBS Trust/PPO |
$5,518.42
|
| Rate for Payer: BCN Commercial |
$5,518.42
|
| Rate for Payer: BCN Medicare Advantage |
$8,245.63
|
| Rate for Payer: Cash Price |
$3,542.15
|
| Rate for Payer: Cash Price |
$3,542.15
|
| Rate for Payer: Cash Price |
$3,542.15
|
| Rate for Payer: Cofinity Advantage |
$3,099.38
|
| Rate for Payer: Cofinity Commercial |
$3,807.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,542.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,245.63
|
| Rate for Payer: Healthscope Commercial |
$3,984.92
|
| Rate for Payer: Mclaren Medicaid |
$4,312.46
|
| Rate for Payer: Mclaren Medicare |
$8,245.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,657.91
|
| Rate for Payer: Meridian Medicaid |
$8,657.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,482.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,070.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,763.54
|
| Rate for Payer: Nomi Health Commercial |
$24,736.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,320.77
|
| Rate for Payer: PACE Medicare |
$7,833.35
|
| Rate for Payer: PACE SWMI |
$8,245.63
|
| Rate for Payer: PHP Commercial |
$3,763.54
|
| Rate for Payer: PHP Medicare Advantage |
$8,245.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,312.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,665.62
|
| Rate for Payer: Priority Health Medicare |
$8,245.63
|
| Rate for Payer: Priority Health SBD |
$2,789.44
|
| Rate for Payer: Priority Health Tiered Network |
$21,332.50
|
| Rate for Payer: Railroad Medicare Medicare |
$8,245.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,245.63
|
| Rate for Payer: UHC Medicaid |
$4,312.46
|
| Rate for Payer: UHCCP Medicaid |
$4,312.46
|
| Rate for Payer: VA VA |
$8,245.63
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$461.05
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$184.42 |
| Max. Negotiated Rate |
$414.94 |
| Rate for Payer: Aetna Commercial |
$391.89
|
| Rate for Payer: Aetna Medicare |
$230.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.68
|
| Rate for Payer: BCBS Complete |
$184.42
|
| Rate for Payer: BCBS Trust/PPO |
$311.14
|
| Rate for Payer: BCN Commercial |
$311.14
|
| Rate for Payer: Cash Price |
$368.84
|
| Rate for Payer: Cash Price |
$368.84
|
| Rate for Payer: Cofinity Advantage |
$322.74
|
| Rate for Payer: Cofinity Commercial |
$396.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.84
|
| Rate for Payer: Healthscope Commercial |
$414.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$368.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.79
|
| Rate for Payer: PHP Commercial |
$391.89
|
| Rate for Payer: Priority Health SBD |
$290.46
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$461.05
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$290.46 |
| Max. Negotiated Rate |
$414.94 |
| Rate for Payer: Aetna Commercial |
$391.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.68
|
| Rate for Payer: Cash Price |
$368.84
|
| Rate for Payer: Cofinity Advantage |
$322.74
|
| Rate for Payer: Cofinity Commercial |
$396.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.84
|
| Rate for Payer: Healthscope Commercial |
$414.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.79
|
| Rate for Payer: PHP Commercial |
$391.89
|
| Rate for Payer: Priority Health SBD |
$290.46
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: Priority Health SBD |
$48.81
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| 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 |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$14.64
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Mclaren Medicaid |
$7.18
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$14.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$20.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.73
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.60
|
| Rate for Payer: UHC Core |
$20.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.73
|
| Rate for Payer: UHC Exchange |
$20.60
|
| Rate for Payer: UHC Medicaid |
$7.18
|
| Rate for Payer: UHCCP Medicaid |
$7.18
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC SITZ MARKER
|
Facility
|
IP
|
$87.39
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$55.06 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Commercial |
$74.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.80
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Advantage |
$61.17
|
| Rate for Payer: Cofinity Commercial |
$75.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$78.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: PHP Commercial |
$74.28
|
| Rate for Payer: Priority Health SBD |
$55.06
|
|
