|
HC SILVADENE 85 GM
|
Facility
|
IP
|
$106.71
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$80.03 |
| Max. Negotiated Rate |
$106.71 |
| Rate for Payer: Aetna Commercial |
$96.04
|
| Rate for Payer: ASR ASR |
$103.51
|
| Rate for Payer: BCBS Trust/PPO |
$87.63
|
| Rate for Payer: BCN Commercial |
$87.63
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cofinity Commercial |
$100.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.37
|
| Rate for Payer: Healthscope Commercial |
$103.51
|
| Rate for Payer: Healthscope Whirlpool |
$106.71
|
| Rate for Payer: Mclaren Commercial |
$96.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.70
|
| Rate for Payer: Nomi Health Commercial |
$87.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.90
|
|
|
HC SILVER 4X4
|
Facility
|
IP
|
$66.72
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$66.72 |
| Rate for Payer: Aetna Commercial |
$60.05
|
| Rate for Payer: ASR ASR |
$64.72
|
| Rate for Payer: BCBS Trust/PPO |
$54.79
|
| Rate for Payer: BCN Commercial |
$54.79
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cofinity Commercial |
$62.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.38
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Healthscope Whirlpool |
$66.72
|
| Rate for Payer: Mclaren Commercial |
$60.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.71
|
| Rate for Payer: Nomi Health Commercial |
$54.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.71
|
|
|
HC SILVER 4X4
|
Facility
|
OP
|
$66.72
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.69 |
| Max. Negotiated Rate |
$66.72 |
| Rate for Payer: Aetna Commercial |
$60.05
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: ASR ASR |
$64.72
|
| Rate for Payer: BCBS Complete |
$26.69
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$55.01
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cofinity Commercial |
$62.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.38
|
| Rate for Payer: Healthscope Commercial |
$64.72
|
| Rate for Payer: Healthscope Whirlpool |
$66.72
|
| Rate for Payer: Mclaren Commercial |
$60.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.71
|
| Rate for Payer: Nomi Health Commercial |
$54.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$58.46
|
| Rate for Payer: Priority Health Narrow Network |
$46.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.71
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
OP
|
$8,921.49
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,300.95 |
| Max. Negotiated Rate |
$8,921.49 |
| Rate for Payer: Aetna Commercial |
$8,029.34
|
| Rate for Payer: Aetna Medicare |
$3,300.95
|
| Rate for Payer: ASR ASR |
$8,653.85
|
| Rate for Payer: BCBS Complete |
$3,568.60
|
| Rate for Payer: BCBS Trust/PPO |
$7,355.77
|
| Rate for Payer: BCN Commercial |
$7,355.77
|
| Rate for Payer: Cash Price |
$7,137.19
|
| Rate for Payer: Cofinity Commercial |
$8,386.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,137.19
|
| Rate for Payer: Healthscope Commercial |
$8,653.85
|
| Rate for Payer: Healthscope Whirlpool |
$8,921.49
|
| Rate for Payer: Mclaren Commercial |
$8,029.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,137.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,583.27
|
| Rate for Payer: Nomi Health Commercial |
$7,315.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,691.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,817.01
|
| Rate for Payer: Priority Health Narrow Network |
$6,253.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,850.91
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
IP
|
$8,921.49
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,691.12 |
| Max. Negotiated Rate |
$8,921.49 |
| Rate for Payer: Aetna Commercial |
$8,029.34
|
| Rate for Payer: ASR ASR |
$8,653.85
|
| Rate for Payer: BCBS Trust/PPO |
$7,326.33
|
| Rate for Payer: BCN Commercial |
$7,326.33
|
| Rate for Payer: Cash Price |
$7,137.19
|
| Rate for Payer: Cofinity Commercial |
$8,386.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,137.19
|
| Rate for Payer: Healthscope Commercial |
$8,653.85
|
| Rate for Payer: Healthscope Whirlpool |
$8,921.49
|
| Rate for Payer: Mclaren Commercial |
$8,029.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,583.27
|
| Rate for Payer: Nomi Health Commercial |
$7,315.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,691.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,850.91
|
|
|
HC SILVER ROPE
|
Facility
|
OP
|
$55.67
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$55.67 |
| Rate for Payer: Aetna Commercial |
$50.10
|
| Rate for Payer: Aetna Medicare |
$20.60
|
| Rate for Payer: ASR ASR |
$54.00
|
| Rate for Payer: BCBS Complete |
$22.27
|
| Rate for Payer: BCBS Trust/PPO |
$45.90
|
| Rate for Payer: BCN Commercial |
$45.90
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cofinity Commercial |
$52.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Healthscope Whirlpool |
$55.67
|
| Rate for Payer: Mclaren Commercial |
$50.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.32
|
| Rate for Payer: Nomi Health Commercial |
$45.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$48.78
|
| Rate for Payer: Priority Health Narrow Network |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.99
|
|
|
HC SILVER ROPE
|
Facility
|
IP
|
$55.67
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$55.67 |
| Rate for Payer: Aetna Commercial |
$50.10
|
| Rate for Payer: ASR ASR |
$54.00
|
| Rate for Payer: BCBS Trust/PPO |
$45.72
|
| Rate for Payer: BCN Commercial |
$45.72
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cofinity Commercial |
$52.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Healthscope Whirlpool |
$55.67
|
| Rate for Payer: Mclaren Commercial |
$50.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.32
|
| Rate for Payer: Nomi Health Commercial |
$45.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.99
|
|
|
HC SIMIAN B AB
|
Facility
|
IP
|
$92.91
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.68 |
| Max. Negotiated Rate |
$92.91 |
| Rate for Payer: Aetna Commercial |
$83.62
|
| Rate for Payer: ASR ASR |
$90.12
|
| Rate for Payer: BCBS Trust/PPO |
$76.30
|
| Rate for Payer: BCN Commercial |
$76.30
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cofinity Commercial |
$87.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.33
|
| Rate for Payer: Healthscope Commercial |
$90.12
|
| Rate for Payer: Healthscope Whirlpool |
$92.91
|
| Rate for Payer: Mclaren Commercial |
$83.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.97
|
| Rate for Payer: Nomi Health Commercial |
$76.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.76
|
|
|
HC SIMIAN B AB
|
Facility
|
OP
|
$92.91
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$92.91 |
| Rate for Payer: Aetna Commercial |
$83.62
|
| 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 |
$90.12
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$76.60
|
| Rate for Payer: BCN Commercial |
$76.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cofinity Commercial |
$87.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$90.12
|
| Rate for Payer: Healthscope Whirlpool |
$92.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$83.62
|
| Rate for Payer: Mclaren Medicaid |
$12.88
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.97
|
| Rate for Payer: Nomi Health Commercial |
$76.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.68
|
| 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 |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$81.41
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$65.13
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$368.37
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$385.87 |
| Rate for Payer: Aetna Commercial |
$331.53
|
| Rate for Payer: Aetna Medicare |
$248.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: ASR ASR |
$357.32
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$303.72
|
| Rate for Payer: BCN Commercial |
$303.72
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$346.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$357.32
|
| Rate for Payer: Healthscope Whirlpool |
$368.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$248.95
|
| Rate for Payer: Mclaren Commercial |
$331.53
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$136.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$273.85
|
| Rate for Payer: PHP Medicaid |
$133.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$322.77
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Narrow Network |
$258.23
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$385.87
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP DNSP |
$248.95
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$368.37
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.28 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$331.53
|
| Rate for Payer: ASR ASR |
$357.32
|
| Rate for Payer: BCBS Trust/PPO |
$302.51
|
| Rate for Payer: BCN Commercial |
$302.51
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$346.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Healthscope Commercial |
$357.32
|
| Rate for Payer: Healthscope Whirlpool |
$368.37
|
| Rate for Payer: Mclaren Commercial |
$331.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$324.17
|
|
|
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 |
$573.24 |
| Rate for Payer: Aetna Commercial |
$515.92
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$556.04
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$472.64
|
| Rate for Payer: BCN Commercial |
$472.64
|
| 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: Cofinity Commercial |
$538.85
|
| 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 |
$556.04
|
| Rate for Payer: Healthscope Whirlpool |
$573.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$515.92
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| 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 |
$109.79
|
| 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 |
$470.06
|
| 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 |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| 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/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| 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 |
$429.93 |
| Max. Negotiated Rate |
$573.24 |
| Rate for Payer: Aetna Commercial |
$515.92
|
| Rate for Payer: ASR ASR |
$556.04
|
| Rate for Payer: BCBS Trust/PPO |
$470.74
|
| Rate for Payer: BCN Commercial |
$470.74
|
| Rate for Payer: Cash Price |
$458.59
|
| Rate for Payer: Cofinity Commercial |
$538.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.59
|
| Rate for Payer: Healthscope Commercial |
$556.04
|
| Rate for Payer: Healthscope Whirlpool |
$573.24
|
| Rate for Payer: Mclaren Commercial |
$515.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.25
|
| Rate for Payer: Nomi Health Commercial |
$470.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.45
|
|
|
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 |
$488.07 |
| Max. Negotiated Rate |
$650.76 |
| Rate for Payer: Aetna Commercial |
$585.68
|
| Rate for Payer: ASR ASR |
$631.24
|
| Rate for Payer: BCBS Trust/PPO |
$534.40
|
| Rate for Payer: BCN Commercial |
$534.40
|
| Rate for Payer: Cash Price |
$520.61
|
| Rate for Payer: Cofinity Commercial |
$611.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.61
|
| Rate for Payer: Healthscope Commercial |
$631.24
|
| Rate for Payer: Healthscope Whirlpool |
$650.76
|
| Rate for Payer: Mclaren Commercial |
$585.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.15
|
| Rate for Payer: Nomi Health Commercial |
$533.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.67
|
|
|
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 |
$650.76 |
| Rate for Payer: Aetna Commercial |
$585.68
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$631.24
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$536.55
|
| Rate for Payer: BCN Commercial |
$536.55
|
| 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: Cofinity Commercial |
$611.71
|
| 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 |
$631.24
|
| Rate for Payer: Healthscope Whirlpool |
$650.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$585.68
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| 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 |
$109.79
|
| 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 |
$533.62
|
| 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 |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| 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/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| 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 |
$208.60 |
| Max. Negotiated Rate |
$278.14 |
| Rate for Payer: Aetna Commercial |
$250.33
|
| Rate for Payer: ASR ASR |
$269.80
|
| Rate for Payer: BCBS Trust/PPO |
$228.41
|
| Rate for Payer: BCN Commercial |
$228.41
|
| Rate for Payer: Cash Price |
$222.51
|
| Rate for Payer: Cofinity Commercial |
$261.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.51
|
| Rate for Payer: Healthscope Commercial |
$269.80
|
| Rate for Payer: Healthscope Whirlpool |
$278.14
|
| Rate for Payer: Mclaren Commercial |
$250.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.42
|
| Rate for Payer: Nomi Health Commercial |
$228.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.76
|
|
|
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 |
$309.86 |
| Rate for Payer: Aetna Commercial |
$250.33
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$269.80
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$229.33
|
| Rate for Payer: BCN Commercial |
$229.33
|
| 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: Cofinity Commercial |
$261.45
|
| 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 |
$269.80
|
| Rate for Payer: Healthscope Whirlpool |
$278.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$250.33
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| 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 |
$109.79
|
| 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 |
$228.07
|
| 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 |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| 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/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| 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 |
$112.54 |
| Max. Negotiated Rate |
$150.05 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: ASR ASR |
$145.55
|
| Rate for Payer: BCBS Trust/PPO |
$123.22
|
| Rate for Payer: BCN Commercial |
$123.22
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$141.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$145.55
|
| Rate for Payer: Healthscope Whirlpool |
$150.05
|
| Rate for Payer: Mclaren Commercial |
$135.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.04
|
|
|
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 |
$104.55 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Commercial |
$135.04
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$145.55
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$123.72
|
| Rate for Payer: BCN Commercial |
$123.72
|
| 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: Cofinity Commercial |
$141.05
|
| 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 |
$145.55
|
| Rate for Payer: Healthscope Whirlpool |
$150.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$135.04
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| 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 |
$109.79
|
| 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 |
$123.04
|
| 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 |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| 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/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| 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 |
$425.71 |
| Max. Negotiated Rate |
$567.61 |
| Rate for Payer: Aetna Commercial |
$510.85
|
| Rate for Payer: ASR ASR |
$550.58
|
| Rate for Payer: BCBS Trust/PPO |
$466.12
|
| Rate for Payer: BCN Commercial |
$466.12
|
| Rate for Payer: Cash Price |
$454.09
|
| Rate for Payer: Cofinity Commercial |
$533.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.09
|
| Rate for Payer: Healthscope Commercial |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$567.61
|
| Rate for Payer: Mclaren Commercial |
$510.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.47
|
| Rate for Payer: Nomi Health Commercial |
$465.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.50
|
|
|
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 |
$567.61 |
| Rate for Payer: Aetna Commercial |
$510.85
|
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: ASR ASR |
$550.58
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$467.99
|
| Rate for Payer: BCN Commercial |
$467.99
|
| 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: Cofinity Commercial |
$533.55
|
| 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 |
$550.58
|
| Rate for Payer: Healthscope Whirlpool |
$567.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Commercial |
$510.85
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| 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 |
$109.79
|
| 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 |
$465.44
|
| 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 |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| 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/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$499.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,353.80
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$721.30 |
| Max. Negotiated Rate |
$5,353.80 |
| Rate for Payer: Aetna Commercial |
$4,818.42
|
| Rate for Payer: Aetna Medicare |
$1,379.15
|
| 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: ASR ASR |
$5,193.19
|
| Rate for Payer: BCBS Complete |
$757.43
|
| Rate for Payer: BCBS MAPPO |
$1,379.15
|
| Rate for Payer: BCBS Trust/PPO |
$4,414.21
|
| Rate for Payer: BCN Commercial |
$4,414.21
|
| 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 Commercial |
$5,032.57
|
| 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 |
$5,193.19
|
| Rate for Payer: Healthscope Whirlpool |
$5,353.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,379.15
|
| Rate for Payer: Mclaren Commercial |
$4,818.42
|
| Rate for Payer: Mclaren Medicaid |
$1,379.15
|
| 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 |
$757.43
|
| 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 |
$4,390.12
|
| 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 |
$1,517.07
|
| Rate for Payer: PHP Medicaid |
$739.22
|
| 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/Tiered Network |
$4,691.00
|
| Rate for Payer: Priority Health Medicare |
$1,379.15
|
| Rate for Payer: Priority Health Narrow Network |
$3,753.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,379.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,711.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,379.15
|
| Rate for Payer: UHC Exchange |
$2,137.68
|
| Rate for Payer: UHC Medicaid |
$721.30
|
| Rate for Payer: UHCCP DNSP |
$1,379.15
|
| Rate for Payer: UHCCP Medicaid |
$721.30
|
| Rate for Payer: VA VA |
$1,379.15
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,353.80
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,015.35 |
| Max. Negotiated Rate |
$5,353.80 |
| Rate for Payer: Aetna Commercial |
$4,818.42
|
| Rate for Payer: ASR ASR |
$5,193.19
|
| Rate for Payer: BCBS Trust/PPO |
$4,396.54
|
| Rate for Payer: BCN Commercial |
$4,396.54
|
| Rate for Payer: Cash Price |
$4,283.04
|
| Rate for Payer: Cofinity Commercial |
$5,032.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,283.04
|
| Rate for Payer: Healthscope Commercial |
$5,193.19
|
| Rate for Payer: Healthscope Whirlpool |
$5,353.80
|
| Rate for Payer: Mclaren Commercial |
$4,818.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,550.73
|
| Rate for Payer: Nomi Health Commercial |
$4,390.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,015.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,711.34
|
|
|
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 |
$1,741.45 |
| Rate for Payer: Aetna Commercial |
$1,567.31
|
| Rate for Payer: Aetna Medicare |
$373.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$466.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$466.35
|
| Rate for Payer: ASR ASR |
$1,689.21
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,435.83
|
| Rate for Payer: BCN Commercial |
$1,435.83
|
| 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 Commercial |
$1,636.96
|
| 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 |
$1,689.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,741.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$373.08
|
| Rate for Payer: Mclaren Commercial |
$1,567.31
|
| Rate for Payer: Mclaren Medicaid |
$373.08
|
| 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 |
$204.90
|
| 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 |
$1,427.99
|
| 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 |
$410.39
|
| Rate for Payer: PHP Medicaid |
$199.97
|
| 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/Tiered Network |
$1,525.86
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,220.76
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,532.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.08
|
| Rate for Payer: UHC Exchange |
$578.27
|
| Rate for Payer: UHC Medicaid |
$195.12
|
| Rate for Payer: UHCCP DNSP |
$373.08
|
| 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 |
$1,306.09 |
| Max. Negotiated Rate |
$1,741.45 |
| Rate for Payer: Aetna Commercial |
$1,567.31
|
| Rate for Payer: ASR ASR |
$1,689.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,430.08
|
| Rate for Payer: BCN Commercial |
$1,430.08
|
| Rate for Payer: Cash Price |
$1,393.16
|
| Rate for Payer: Cofinity Commercial |
$1,636.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.16
|
| Rate for Payer: Healthscope Commercial |
$1,689.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,741.45
|
| Rate for Payer: Mclaren Commercial |
$1,567.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.23
|
| Rate for Payer: Nomi Health Commercial |
$1,427.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,306.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,532.48
|
|
