|
HC SILVER HAWK CATHETER
|
Facility
|
IP
|
$8,575.06
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,002.54 |
| Max. Negotiated Rate |
$8,575.06 |
| Rate for Payer: Aetna Commercial |
$7,717.55
|
| Rate for Payer: ASR ASR |
$8,317.81
|
| Rate for Payer: BCBS Trust/PPO |
$6,648.24
|
| Rate for Payer: BCN Commercial |
$6,648.24
|
| Rate for Payer: Cash Price |
$6,860.05
|
| Rate for Payer: Cofinity Commercial |
$8,060.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,860.05
|
| Rate for Payer: Healthscope Commercial |
$8,575.06
|
| Rate for Payer: Healthscope Whirlpool |
$8,317.81
|
| Rate for Payer: Mclaren Commercial |
$7,717.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,288.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,002.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,546.05
|
|
|
HC SILVER ROPE
|
Facility
|
IP
|
$53.51
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.46 |
| Max. Negotiated Rate |
$53.51 |
| Rate for Payer: Aetna Commercial |
$48.16
|
| Rate for Payer: ASR ASR |
$51.90
|
| Rate for Payer: BCBS Trust/PPO |
$41.49
|
| Rate for Payer: BCN Commercial |
$41.49
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$50.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$53.51
|
| Rate for Payer: Healthscope Whirlpool |
$51.90
|
| Rate for Payer: Mclaren Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.09
|
|
|
HC SILVER ROPE
|
Facility
|
OP
|
$53.51
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$53.51 |
| Rate for Payer: Aetna Commercial |
$48.16
|
| Rate for Payer: ASR ASR |
$51.90
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.49
|
| Rate for Payer: BCN Commercial |
$41.49
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$50.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$53.51
|
| Rate for Payer: Healthscope Whirlpool |
$51.90
|
| Rate for Payer: Mclaren Commercial |
$48.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.69
|
| Rate for Payer: Priority Health Narrow Network |
$37.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.09
|
|
|
HC SIMIAN B AB
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.51 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Aetna Commercial |
$80.37
|
| Rate for Payer: ASR ASR |
$86.62
|
| Rate for Payer: BCBS Trust/PPO |
$69.23
|
| Rate for Payer: BCN Commercial |
$69.23
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$83.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$89.30
|
| Rate for Payer: Healthscope Whirlpool |
$86.62
|
| Rate for Payer: Mclaren Commercial |
$80.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.58
|
|
|
HC SIMIAN B AB
|
Facility
|
OP
|
$89.30
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Aetna Commercial |
$80.37
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$86.62
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$69.23
|
| Rate for Payer: BCN Commercial |
$69.23
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$83.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$89.30
|
| Rate for Payer: Healthscope Whirlpool |
$86.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$80.37
|
| Rate for Payer: Mclaren Medicaid |
$7.05
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Medicaid |
$7.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$14.17
|
| Rate for Payer: PHP Medicaid |
$7.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.26
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$63.40
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.58
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$354.07
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$354.07 |
| Rate for Payer: Aetna Commercial |
$318.66
|
| Rate for Payer: Aetna Medicare |
$219.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: ASR ASR |
$343.45
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$274.51
|
| Rate for Payer: BCN Commercial |
$274.51
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$332.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$354.07
|
| Rate for Payer: Healthscope Whirlpool |
$343.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.68
|
| Rate for Payer: Mclaren Commercial |
$318.66
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Commercial |
$241.65
|
| Rate for Payer: PHP Medicaid |
$120.16
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.20
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$251.39
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.58
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$354.07
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.85 |
| Max. Negotiated Rate |
$354.07 |
| Rate for Payer: Aetna Commercial |
$318.66
|
| Rate for Payer: ASR ASR |
$343.45
|
| Rate for Payer: BCBS Trust/PPO |
$274.51
|
| Rate for Payer: BCN Commercial |
$274.51
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$332.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.26
|
| Rate for Payer: Healthscope Commercial |
$354.07
|
| Rate for Payer: Healthscope Whirlpool |
$343.45
|
| Rate for Payer: Mclaren Commercial |
$318.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$311.58
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$267.34
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$267.34 |
| Rate for Payer: Aetna Commercial |
$240.61
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$259.32
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$207.27
|
| Rate for Payer: BCN Commercial |
$207.27
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$251.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$267.34
|
| Rate for Payer: Healthscope Whirlpool |
$259.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$240.61
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.26
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$267.34
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.14 |
| Max. Negotiated Rate |
$267.34 |
| Rate for Payer: Aetna Commercial |
$240.61
|
| Rate for Payer: ASR ASR |
$259.32
|
| Rate for Payer: BCBS Trust/PPO |
$207.27
|
| Rate for Payer: BCN Commercial |
$207.27
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$251.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.87
|
| Rate for Payer: Healthscope Commercial |
$267.34
|
| Rate for Payer: Healthscope Whirlpool |
$259.32
|
| Rate for Payer: Mclaren Commercial |
$240.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.26
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$144.23
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$248.58 |
| Rate for Payer: Aetna Commercial |
$129.81
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$139.90
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$111.82
|
| Rate for Payer: BCN Commercial |
$111.82
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$135.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$144.23
|
| Rate for Payer: Healthscope Whirlpool |
$139.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$129.81
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.92
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$144.23
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.96 |
| Max. Negotiated Rate |
$144.23 |
| Rate for Payer: Aetna Commercial |
$129.81
|
| Rate for Payer: ASR ASR |
$139.90
|
| Rate for Payer: BCBS Trust/PPO |
$111.82
|
| Rate for Payer: BCN Commercial |
$111.82
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$135.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.38
|
| Rate for Payer: Healthscope Commercial |
$144.23
|
| Rate for Payer: Healthscope Whirlpool |
$139.90
|
| Rate for Payer: Mclaren Commercial |
$129.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.92
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$545.57
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$545.57 |
| Rate for Payer: Aetna Commercial |
$491.01
|
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: ASR ASR |
$529.20
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCBS Trust/PPO |
$422.98
|
| Rate for Payer: BCN Commercial |
$422.98
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cofinity Commercial |
$512.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Healthscope Commercial |
$545.57
|
| Rate for Payer: Healthscope Whirlpool |
$529.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Commercial |
$491.01
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.73
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.10
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$545.57
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.90 |
| Max. Negotiated Rate |
$545.57 |
| Rate for Payer: Aetna Commercial |
$491.01
|
| Rate for Payer: ASR ASR |
$529.20
|
| Rate for Payer: BCBS Trust/PPO |
$422.98
|
| Rate for Payer: BCN Commercial |
$422.98
|
| Rate for Payer: Cash Price |
$436.46
|
| Rate for Payer: Cofinity Commercial |
$512.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.46
|
| Rate for Payer: Healthscope Commercial |
$545.57
|
| Rate for Payer: Healthscope Whirlpool |
$529.20
|
| Rate for Payer: Mclaren Commercial |
$491.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.10
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,145.90
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,602.13 |
| Max. Negotiated Rate |
$5,145.90 |
| Rate for Payer: Aetna Commercial |
$4,631.31
|
| Rate for Payer: Aetna Commercial |
$7,975.80
|
| Rate for Payer: ASR ASR |
$8,596.14
|
| Rate for Payer: ASR ASR |
$4,991.52
|
| Rate for Payer: BCBS Trust/PPO |
$6,870.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,989.62
|
| Rate for Payer: BCN Commercial |
$3,989.62
|
| Rate for Payer: BCN Commercial |
$6,870.71
|
| Rate for Payer: Cash Price |
$4,116.72
|
| Rate for Payer: Cash Price |
$7,089.60
|
| Rate for Payer: Cofinity Commercial |
$8,330.28
|
| Rate for Payer: Cofinity Commercial |
$4,837.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,089.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,116.72
|
| Rate for Payer: Healthscope Commercial |
$5,145.90
|
| Rate for Payer: Healthscope Commercial |
$8,862.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,991.52
|
| Rate for Payer: Healthscope Whirlpool |
$8,596.14
|
| Rate for Payer: Mclaren Commercial |
$7,975.80
|
| Rate for Payer: Mclaren Commercial |
$4,631.31
|
| 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: Priority Health Cigna Priority Health |
$3,602.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,203.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,528.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,798.56
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$8,862.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$673.71 |
| Max. Negotiated Rate |
$8,862.00 |
| Rate for Payer: Aetna Commercial |
$7,975.80
|
| Rate for Payer: Aetna Commercial |
$4,631.31
|
| Rate for Payer: Aetna Medicare |
$1,231.65
|
| Rate for Payer: Aetna Medicare |
$1,231.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,539.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,539.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,539.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,539.56
|
| Rate for Payer: ASR ASR |
$4,991.52
|
| Rate for Payer: ASR ASR |
$8,596.14
|
| Rate for Payer: BCBS Complete |
$707.46
|
| Rate for Payer: BCBS Complete |
$707.46
|
| Rate for Payer: BCBS MAPPO |
$1,231.65
|
| Rate for Payer: BCBS MAPPO |
$1,231.65
|
| Rate for Payer: BCBS Trust/PPO |
$6,870.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,989.62
|
| Rate for Payer: BCN Commercial |
$3,989.62
|
| Rate for Payer: BCN Commercial |
$6,870.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,231.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,231.65
|
| 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 |
$8,330.28
|
| Rate for Payer: Cofinity Commercial |
$4,837.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,116.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,089.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,231.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,231.65
|
| Rate for Payer: Healthscope Commercial |
$5,145.90
|
| Rate for Payer: Healthscope Commercial |
$8,862.00
|
| Rate for Payer: Healthscope Whirlpool |
$8,596.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,991.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,231.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,231.65
|
| Rate for Payer: Mclaren Commercial |
$7,975.80
|
| Rate for Payer: Mclaren Commercial |
$4,631.31
|
| Rate for Payer: Mclaren Medicaid |
$673.71
|
| Rate for Payer: Mclaren Medicaid |
$673.71
|
| Rate for Payer: Mclaren Medicare |
$1,231.65
|
| Rate for Payer: Mclaren Medicare |
$1,231.65
|
| Rate for Payer: Meridian Medicaid |
$707.46
|
| Rate for Payer: Meridian Medicaid |
$707.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,293.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,293.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,416.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,416.40
|
| 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 |
$1,170.07
|
| Rate for Payer: PACE Medicare |
$1,170.07
|
| Rate for Payer: PACE SWMI |
$1,231.65
|
| Rate for Payer: PACE SWMI |
$1,231.65
|
| Rate for Payer: PHP Commercial |
$1,354.82
|
| Rate for Payer: PHP Commercial |
$1,354.82
|
| Rate for Payer: PHP Medicaid |
$673.71
|
| Rate for Payer: PHP Medicaid |
$673.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,231.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,231.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.71
|
| 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 HMO/PPO/Tiered Network |
$8,064.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,682.77
|
| Rate for Payer: Priority Health Medicare |
$1,231.65
|
| Rate for Payer: Priority Health Medicare |
$1,231.65
|
| Rate for Payer: Priority Health Narrow Network |
$6,292.02
|
| Rate for Payer: Priority Health Narrow Network |
$3,653.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,231.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,231.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,528.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,798.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,268.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,268.60
|
| Rate for Payer: VA VA |
$1,231.65
|
| Rate for Payer: VA VA |
$1,231.65
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$1,673.82
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,171.67 |
| Max. Negotiated Rate |
$1,673.82 |
| Rate for Payer: Aetna Commercial |
$1,506.44
|
| Rate for Payer: Aetna Commercial |
$2,754.90
|
| Rate for Payer: ASR ASR |
$1,623.61
|
| Rate for Payer: ASR ASR |
$2,969.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,373.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,297.71
|
| Rate for Payer: BCN Commercial |
$1,297.71
|
| Rate for Payer: BCN Commercial |
$2,373.19
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cofinity Commercial |
$2,877.34
|
| Rate for Payer: Cofinity Commercial |
$1,573.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,339.06
|
| Rate for Payer: Healthscope Commercial |
$1,673.82
|
| Rate for Payer: Healthscope Commercial |
$3,061.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,969.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,623.61
|
| Rate for Payer: Mclaren Commercial |
$1,506.44
|
| Rate for Payer: Mclaren 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: Priority Health Cigna Priority Health |
$1,171.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,472.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,693.68
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$1,673.82
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.65 |
| Max. Negotiated Rate |
$1,673.82 |
| Rate for Payer: Aetna Commercial |
$1,506.44
|
| Rate for Payer: Aetna Commercial |
$2,754.90
|
| Rate for Payer: Aetna Medicare |
$328.43
|
| Rate for Payer: Aetna Medicare |
$328.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.54
|
| Rate for Payer: ASR ASR |
$1,623.61
|
| Rate for Payer: ASR ASR |
$2,969.17
|
| Rate for Payer: BCBS Complete |
$188.65
|
| Rate for Payer: BCBS Complete |
$188.65
|
| Rate for Payer: BCBS MAPPO |
$328.43
|
| Rate for Payer: BCBS MAPPO |
$328.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,297.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,373.19
|
| Rate for Payer: BCN Commercial |
$1,297.71
|
| Rate for Payer: BCN Commercial |
$2,373.19
|
| Rate for Payer: BCN Medicare Advantage |
$328.43
|
| Rate for Payer: BCN Medicare Advantage |
$328.43
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cash Price |
$1,339.06
|
| Rate for Payer: Cash Price |
$2,448.80
|
| Rate for Payer: Cofinity Commercial |
$1,573.39
|
| Rate for Payer: Cofinity Commercial |
$2,877.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,339.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.43
|
| Rate for Payer: Healthscope Commercial |
$1,673.82
|
| Rate for Payer: Healthscope Commercial |
$3,061.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,623.61
|
| Rate for Payer: Healthscope Whirlpool |
$2,969.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$328.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$328.43
|
| Rate for Payer: Mclaren Commercial |
$1,506.44
|
| Rate for Payer: Mclaren Commercial |
$2,754.90
|
| Rate for Payer: Mclaren Medicaid |
$179.65
|
| Rate for Payer: Mclaren Medicaid |
$179.65
|
| Rate for Payer: Mclaren Medicare |
$328.43
|
| Rate for Payer: Mclaren Medicare |
$328.43
|
| Rate for Payer: Meridian Medicaid |
$188.65
|
| Rate for Payer: Meridian Medicaid |
$188.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.69
|
| 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 |
$312.01
|
| Rate for Payer: PACE Medicare |
$312.01
|
| Rate for Payer: PACE SWMI |
$328.43
|
| Rate for Payer: PACE SWMI |
$328.43
|
| Rate for Payer: PHP Commercial |
$361.27
|
| Rate for Payer: PHP Commercial |
$361.27
|
| Rate for Payer: PHP Medicaid |
$179.65
|
| Rate for Payer: PHP Medicaid |
$179.65
|
| Rate for Payer: PHP Medicare Advantage |
$328.43
|
| Rate for Payer: PHP Medicare Advantage |
$328.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,785.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,523.18
|
| Rate for Payer: Priority Health Medicare |
$328.43
|
| Rate for Payer: Priority Health Medicare |
$328.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,188.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,173.31
|
| Rate for Payer: Railroad Medicare Medicare |
$328.43
|
| Rate for Payer: Railroad Medicare Medicare |
$328.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,693.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,472.96
|
| Rate for Payer: UHC Medicare Advantage |
$338.28
|
| Rate for Payer: UHC Medicare Advantage |
$338.28
|
| Rate for Payer: VA VA |
$328.43
|
| Rate for Payer: VA VA |
$328.43
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$2,642.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$179.65 |
| Max. Negotiated Rate |
$2,642.00 |
| Rate for Payer: Aetna Commercial |
$2,377.80
|
| Rate for Payer: Aetna Commercial |
$1,053.00
|
| Rate for Payer: Aetna Medicare |
$328.43
|
| Rate for Payer: Aetna Medicare |
$328.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.54
|
| Rate for Payer: ASR ASR |
$1,134.90
|
| Rate for Payer: ASR ASR |
$2,562.74
|
| Rate for Payer: BCBS Complete |
$188.65
|
| Rate for Payer: BCBS Complete |
$188.65
|
| Rate for Payer: BCBS MAPPO |
$328.43
|
| Rate for Payer: BCBS MAPPO |
$328.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.34
|
| Rate for Payer: BCBS Trust/PPO |
$907.10
|
| Rate for Payer: BCN Commercial |
$907.10
|
| Rate for Payer: BCN Commercial |
$2,048.34
|
| Rate for Payer: BCN Medicare Advantage |
$328.43
|
| Rate for Payer: BCN Medicare Advantage |
$328.43
|
| 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: Cash Price |
$2,113.60
|
| Rate for Payer: Cofinity Commercial |
$2,483.48
|
| Rate for Payer: Cofinity Commercial |
$1,099.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.43
|
| Rate for Payer: Healthscope Commercial |
$1,170.00
|
| Rate for Payer: Healthscope Commercial |
$2,642.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,562.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$328.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$328.43
|
| Rate for Payer: Mclaren Commercial |
$2,377.80
|
| Rate for Payer: Mclaren Commercial |
$1,053.00
|
| Rate for Payer: Mclaren Medicaid |
$179.65
|
| Rate for Payer: Mclaren Medicaid |
$179.65
|
| Rate for Payer: Mclaren Medicare |
$328.43
|
| Rate for Payer: Mclaren Medicare |
$328.43
|
| Rate for Payer: Meridian Medicaid |
$188.65
|
| Rate for Payer: Meridian Medicaid |
$188.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$344.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.69
|
| 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 |
$312.01
|
| Rate for Payer: PACE Medicare |
$312.01
|
| Rate for Payer: PACE SWMI |
$328.43
|
| Rate for Payer: PACE SWMI |
$328.43
|
| Rate for Payer: PHP Commercial |
$361.27
|
| Rate for Payer: PHP Commercial |
$361.27
|
| Rate for Payer: PHP Medicaid |
$179.65
|
| Rate for Payer: PHP Medicaid |
$179.65
|
| Rate for Payer: PHP Medicare Advantage |
$328.43
|
| Rate for Payer: PHP Medicare Advantage |
$328.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,064.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,404.22
|
| Rate for Payer: Priority Health Medicare |
$328.43
|
| Rate for Payer: Priority Health Medicare |
$328.43
|
| Rate for Payer: Priority Health Narrow Network |
$830.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,875.82
|
| Rate for Payer: Railroad Medicare Medicare |
$328.43
|
| Rate for Payer: Railroad Medicare Medicare |
$328.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,029.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,324.96
|
| Rate for Payer: UHC Medicare Advantage |
$338.28
|
| Rate for Payer: UHC Medicare Advantage |
$338.28
|
| Rate for Payer: VA VA |
$328.43
|
| Rate for Payer: VA VA |
$328.43
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$2,642.00
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,849.40 |
| Max. Negotiated Rate |
$2,642.00 |
| Rate for Payer: Aetna Commercial |
$2,377.80
|
| Rate for Payer: Aetna Commercial |
$1,053.00
|
| Rate for Payer: ASR ASR |
$1,134.90
|
| Rate for Payer: ASR ASR |
$2,562.74
|
| Rate for Payer: BCBS Trust/PPO |
$907.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.34
|
| Rate for Payer: BCN Commercial |
$2,048.34
|
| Rate for Payer: BCN Commercial |
$907.10
|
| Rate for Payer: Cash Price |
$2,113.60
|
| Rate for Payer: Cash Price |
$936.00
|
| Rate for Payer: Cofinity Commercial |
$1,099.80
|
| Rate for Payer: Cofinity Commercial |
$2,483.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.60
|
| Rate for Payer: Healthscope Commercial |
$1,170.00
|
| Rate for Payer: Healthscope Commercial |
$2,642.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,562.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,134.90
|
| Rate for Payer: Mclaren Commercial |
$1,053.00
|
| Rate for Payer: Mclaren 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: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,849.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,324.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,029.60
|
|
|
HC SIMULATION - S
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$65.97 |
| Max. Negotiated Rate |
$1,591.00 |
| Rate for Payer: Aetna Commercial |
$1,431.90
|
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.76
|
| Rate for Payer: ASR ASR |
$1,543.27
|
| Rate for Payer: ASR ASR |
$692.58
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS Complete |
$69.28
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCBS Trust/PPO |
$553.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.50
|
| Rate for Payer: BCN Commercial |
$553.56
|
| Rate for Payer: BCN Commercial |
$1,233.50
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| 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 |
$671.16
|
| Rate for Payer: Cofinity Commercial |
$1,495.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$714.00
|
| Rate for Payer: Healthscope Commercial |
$1,591.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,543.27
|
| Rate for Payer: Healthscope Whirlpool |
$692.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$120.61
|
| Rate for Payer: Mclaren Commercial |
$1,431.90
|
| Rate for Payer: Mclaren Commercial |
$642.60
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicaid |
$65.97
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Mclaren Medicare |
$120.61
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Medicaid |
$69.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.70
|
| 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 |
$114.58
|
| Rate for Payer: PACE Medicare |
$114.58
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Commercial |
$132.67
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicaid |
$65.97
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.97
|
| 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 HMO/PPO/Tiered Network |
$649.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,447.81
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,129.61
|
| Rate for Payer: Priority Health Narrow Network |
$506.94
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: Railroad Medicare Medicare |
$120.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,400.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.32
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: UHC Medicare Advantage |
$124.23
|
| Rate for Payer: VA VA |
$120.61
|
| Rate for Payer: VA VA |
$120.61
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$714.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Commercial |
$1,431.90
|
| Rate for Payer: ASR ASR |
$1,543.27
|
| Rate for Payer: ASR ASR |
$692.58
|
| Rate for Payer: BCBS Trust/PPO |
$553.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.50
|
| Rate for Payer: BCN Commercial |
$1,233.50
|
| Rate for Payer: BCN Commercial |
$553.56
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$1,495.54
|
| Rate for Payer: Cofinity Commercial |
$671.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.80
|
| Rate for Payer: Healthscope Commercial |
$714.00
|
| Rate for Payer: Healthscope Commercial |
$1,591.00
|
| Rate for Payer: Healthscope Whirlpool |
$692.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,543.27
|
| Rate for Payer: Mclaren Commercial |
$1,431.90
|
| Rate for Payer: Mclaren Commercial |
$642.60
|
| 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: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$628.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,400.08
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,255.75
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,979.02 |
| Max. Negotiated Rate |
$9,439.52 |
| Rate for Payer: Aetna Commercial |
$3,830.18
|
| Rate for Payer: Aetna Medicare |
$7,551.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,439.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,439.52
|
| Rate for Payer: ASR ASR |
$4,128.08
|
| Rate for Payer: BCBS Complete |
$4,337.65
|
| Rate for Payer: BCBS MAPPO |
$7,551.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,299.48
|
| Rate for Payer: BCN Commercial |
$3,299.48
|
| Rate for Payer: BCN Medicare Advantage |
$7,551.62
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cofinity Commercial |
$4,000.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,404.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,551.62
|
| Rate for Payer: Healthscope Commercial |
$4,255.75
|
| Rate for Payer: Healthscope Whirlpool |
$4,128.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,551.62
|
| Rate for Payer: Mclaren Commercial |
$3,830.18
|
| Rate for Payer: Mclaren Medicaid |
$4,130.74
|
| Rate for Payer: Mclaren Medicare |
$7,551.62
|
| Rate for Payer: Meridian Medicaid |
$4,337.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,929.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,684.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,617.39
|
| Rate for Payer: PACE Medicare |
$7,174.04
|
| Rate for Payer: PACE SWMI |
$7,551.62
|
| Rate for Payer: PHP Commercial |
$8,306.78
|
| Rate for Payer: PHP Medicaid |
$4,130.74
|
| Rate for Payer: PHP Medicare Advantage |
$7,551.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,130.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,979.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,872.73
|
| Rate for Payer: Priority Health Medicare |
$7,551.62
|
| Rate for Payer: Priority Health Narrow Network |
$3,021.58
|
| Rate for Payer: Railroad Medicare Medicare |
$7,551.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,745.06
|
| Rate for Payer: UHC Medicare Advantage |
$7,778.17
|
| Rate for Payer: VA VA |
$7,551.62
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,255.75
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,979.02 |
| Max. Negotiated Rate |
$4,255.75 |
| Rate for Payer: Aetna Commercial |
$3,830.18
|
| Rate for Payer: ASR ASR |
$4,128.08
|
| Rate for Payer: BCBS Trust/PPO |
$3,299.48
|
| Rate for Payer: BCN Commercial |
$3,299.48
|
| Rate for Payer: Cash Price |
$3,404.60
|
| Rate for Payer: Cofinity Commercial |
$4,000.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,404.60
|
| Rate for Payer: Healthscope Commercial |
$4,255.75
|
| Rate for Payer: Healthscope Whirlpool |
$4,128.08
|
| Rate for Payer: Mclaren Commercial |
$3,830.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,617.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,979.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,745.06
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$443.15
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$443.15 |
| Rate for Payer: Aetna Commercial |
$398.84
|
| Rate for Payer: ASR ASR |
$429.86
|
| Rate for Payer: BCBS Trust/PPO |
$343.57
|
| Rate for Payer: BCN Commercial |
$343.57
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cofinity Commercial |
$416.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.52
|
| Rate for Payer: Healthscope Commercial |
$443.15
|
| Rate for Payer: Healthscope Whirlpool |
$429.86
|
| Rate for Payer: Mclaren Commercial |
$398.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.97
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$443.15
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.26 |
| Max. Negotiated Rate |
$443.15 |
| Rate for Payer: Aetna Commercial |
$398.84
|
| Rate for Payer: ASR ASR |
$429.86
|
| Rate for Payer: BCBS Complete |
$177.26
|
| Rate for Payer: BCBS Trust/PPO |
$343.57
|
| Rate for Payer: BCN Commercial |
$343.57
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cofinity Commercial |
$416.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.52
|
| Rate for Payer: Healthscope Commercial |
$443.15
|
| Rate for Payer: Healthscope Whirlpool |
$429.86
|
| Rate for Payer: Mclaren Commercial |
$398.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.78
|
| Rate for Payer: Priority Health Narrow Network |
$243.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.97
|
|
