|
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 |
$1,217.27 |
| Rate for Payer: Aetna Commercial |
$1,095.54
|
| 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 |
$1,180.75
|
| Rate for Payer: BCBS Complete |
$204.90
|
| Rate for Payer: BCBS MAPPO |
$373.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.64
|
| Rate for Payer: BCN Commercial |
$1,003.64
|
| 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 Commercial |
$1,144.23
|
| 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 |
$1,180.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$373.08
|
| Rate for Payer: Mclaren Commercial |
$1,095.54
|
| 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 |
$1,034.68
|
| Rate for Payer: Nomi Health Commercial |
$998.16
|
| 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 |
$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 |
$1,066.57
|
| Rate for Payer: Priority Health Medicare |
$373.08
|
| Rate for Payer: Priority Health Narrow Network |
$853.31
|
| Rate for Payer: Railroad Medicare Medicare |
$373.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.20
|
| 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 - I
|
Facility
|
IP
|
$1,217.27
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$912.95 |
| Max. Negotiated Rate |
$1,217.27 |
| Rate for Payer: Aetna Commercial |
$1,095.54
|
| Rate for Payer: ASR ASR |
$1,180.75
|
| Rate for Payer: BCBS Trust/PPO |
$999.62
|
| Rate for Payer: BCN Commercial |
$999.62
|
| Rate for Payer: Cash Price |
$973.82
|
| Rate for Payer: Cofinity Commercial |
$1,144.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$973.82
|
| Rate for Payer: Healthscope Commercial |
$1,180.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,217.27
|
| Rate for Payer: Mclaren Commercial |
$1,095.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,034.68
|
| Rate for Payer: Nomi Health Commercial |
$998.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,071.20
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$742.85
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$557.14 |
| Max. Negotiated Rate |
$742.85 |
| Rate for Payer: Aetna Commercial |
$668.57
|
| Rate for Payer: ASR ASR |
$720.56
|
| Rate for Payer: BCBS Trust/PPO |
$610.03
|
| Rate for Payer: BCN Commercial |
$610.03
|
| Rate for Payer: Cash Price |
$594.28
|
| Rate for Payer: Cofinity Commercial |
$698.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.28
|
| Rate for Payer: Healthscope Commercial |
$720.56
|
| Rate for Payer: Healthscope Whirlpool |
$742.85
|
| Rate for Payer: Mclaren Commercial |
$668.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$631.42
|
| Rate for Payer: Nomi Health Commercial |
$609.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$653.71
|
|
|
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 |
$742.85 |
| Rate for Payer: Aetna Commercial |
$668.57
|
| Rate for Payer: Aetna Medicare |
$133.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: ASR ASR |
$720.56
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCBS Trust/PPO |
$612.48
|
| Rate for Payer: BCN Commercial |
$612.48
|
| 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 Commercial |
$698.28
|
| 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 |
$720.56
|
| Rate for Payer: Healthscope Whirlpool |
$742.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$133.93
|
| Rate for Payer: Mclaren Commercial |
$668.57
|
| Rate for Payer: Mclaren Medicaid |
$133.93
|
| 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 |
$73.55
|
| 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 |
$609.14
|
| 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 |
$147.32
|
| Rate for Payer: PHP Medicaid |
$71.79
|
| 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/Tiered Network |
$650.89
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health Narrow Network |
$520.74
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$653.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$207.59
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP DNSP |
$133.93
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,427.69
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,320.77 |
| Max. Negotiated Rate |
$4,427.69 |
| Rate for Payer: Aetna Commercial |
$3,984.92
|
| Rate for Payer: ASR ASR |
$4,294.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,636.02
|
| Rate for Payer: BCN Commercial |
$3,636.02
|
| Rate for Payer: Cash Price |
$3,542.15
|
| Rate for Payer: Cofinity Commercial |
$4,162.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,542.15
|
| Rate for Payer: Healthscope Commercial |
$4,294.86
|
| Rate for Payer: Healthscope Whirlpool |
$4,427.69
|
| Rate for Payer: Mclaren Commercial |
$3,984.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,763.54
|
| Rate for Payer: Nomi Health Commercial |
$3,630.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,320.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,896.37
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,427.69
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,103.81 |
| Max. Negotiated Rate |
$12,780.73 |
| Rate for Payer: Aetna Commercial |
$3,984.92
|
| Rate for Payer: Aetna Medicare |
$8,245.63
|
| 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: ASR ASR |
$4,294.86
|
| Rate for Payer: BCBS Complete |
$4,528.50
|
| Rate for Payer: BCBS MAPPO |
$8,245.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,650.63
|
| Rate for Payer: BCN Commercial |
$3,650.63
|
| 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: Cofinity Commercial |
$4,162.03
|
| 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 |
$4,294.86
|
| Rate for Payer: Healthscope Whirlpool |
$4,427.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,245.63
|
| Rate for Payer: Mclaren Commercial |
$3,984.92
|
| Rate for Payer: Mclaren Medicaid |
$8,245.63
|
| 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 |
$4,528.50
|
| 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 |
$3,630.71
|
| 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 |
$9,070.19
|
| Rate for Payer: PHP Medicaid |
$4,419.66
|
| 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/Tiered Network |
$3,879.54
|
| Rate for Payer: Priority Health Medicare |
$8,245.63
|
| Rate for Payer: Priority Health Narrow Network |
$3,103.81
|
| Rate for Payer: Railroad Medicare Medicare |
$8,245.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,896.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,245.63
|
| Rate for Payer: UHC Exchange |
$12,780.73
|
| Rate for Payer: UHC Medicaid |
$4,312.46
|
| Rate for Payer: UHCCP DNSP |
$8,245.63
|
| 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 |
$170.59 |
| Max. Negotiated Rate |
$461.05 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$170.59
|
| Rate for Payer: ASR ASR |
$447.22
|
| Rate for Payer: BCBS Complete |
$184.42
|
| Rate for Payer: BCBS Trust/PPO |
$380.14
|
| Rate for Payer: BCN Commercial |
$380.14
|
| Rate for Payer: Cash Price |
$368.84
|
| Rate for Payer: Cash Price |
$368.84
|
| Rate for Payer: Cofinity Commercial |
$433.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.84
|
| Rate for Payer: Healthscope Commercial |
$447.22
|
| Rate for Payer: Healthscope Whirlpool |
$461.05
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$378.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$359.54
|
| Rate for Payer: Priority Health Narrow Network |
$287.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.72
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$461.05
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.79 |
| Max. Negotiated Rate |
$461.05 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: ASR ASR |
$447.22
|
| Rate for Payer: BCBS Trust/PPO |
$378.61
|
| Rate for Payer: BCN Commercial |
$378.61
|
| Rate for Payer: Cash Price |
$368.84
|
| Rate for Payer: Cofinity Commercial |
$433.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.84
|
| Rate for Payer: Healthscope Commercial |
$447.22
|
| Rate for Payer: Healthscope Whirlpool |
$461.05
|
| Rate for Payer: Mclaren Commercial |
$414.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.89
|
| Rate for Payer: Nomi Health Commercial |
$378.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$405.72
|
|
|
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 |
$77.47 |
| Rate for Payer: Aetna Commercial |
$69.72
|
| Rate for Payer: Aetna Medicare |
$13.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: ASR ASR |
$75.15
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$63.87
|
| Rate for Payer: BCN Commercial |
$63.87
|
| 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 Commercial |
$72.82
|
| 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 |
$75.15
|
| Rate for Payer: Healthscope Whirlpool |
$77.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$69.72
|
| Rate for Payer: Mclaren Medicaid |
$13.73
|
| 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 |
$7.54
|
| 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 |
$63.53
|
| 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 |
$15.10
|
| Rate for Payer: PHP Medicaid |
$7.36
|
| 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/Tiered Network |
$67.88
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$54.31
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.73
|
| Rate for Payer: UHC Exchange |
$21.28
|
| Rate for Payer: UHC Medicaid |
$7.18
|
| Rate for Payer: UHCCP DNSP |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.18
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$77.47 |
| Rate for Payer: Aetna Commercial |
$69.72
|
| Rate for Payer: ASR ASR |
$75.15
|
| Rate for Payer: BCBS Trust/PPO |
$63.62
|
| Rate for Payer: BCN Commercial |
$63.62
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$72.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Healthscope Whirlpool |
$77.47
|
| Rate for Payer: Mclaren Commercial |
$69.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$63.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.17
|
|
|
HC SITZ MARKER
|
Facility
|
IP
|
$87.39
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$65.54 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$78.65
|
| Rate for Payer: ASR ASR |
$84.77
|
| Rate for Payer: BCBS Trust/PPO |
$71.76
|
| Rate for Payer: BCN Commercial |
$71.76
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Commercial |
$82.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$84.77
|
| Rate for Payer: Healthscope Whirlpool |
$87.39
|
| Rate for Payer: Mclaren Commercial |
$78.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Nomi Health Commercial |
$71.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.90
|
|
|
HC SITZ MARKER
|
Facility
|
OP
|
$87.39
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$78.65
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: ASR ASR |
$84.77
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS Trust/PPO |
$72.05
|
| Rate for Payer: BCN Commercial |
$72.05
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cash Price |
$69.91
|
| Rate for Payer: Cofinity Commercial |
$82.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.91
|
| Rate for Payer: Healthscope Commercial |
$84.77
|
| Rate for Payer: Healthscope Whirlpool |
$87.39
|
| Rate for Payer: Mclaren Commercial |
$78.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.28
|
| Rate for Payer: Nomi Health Commercial |
$71.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.27
|
| Rate for Payer: Priority Health Narrow Network |
$61.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.90
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
OP
|
$5,604.91
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$5,604.91 |
| Rate for Payer: Aetna Commercial |
$5,044.42
|
| Rate for Payer: Aetna Medicare |
$2,055.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: ASR ASR |
$5,436.76
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,621.25
|
| Rate for Payer: BCN Commercial |
$4,621.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$4,483.93
|
| Rate for Payer: Cash Price |
$4,483.93
|
| Rate for Payer: Cofinity Commercial |
$5,268.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,483.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$5,436.76
|
| Rate for Payer: Healthscope Whirlpool |
$5,604.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,055.86
|
| Rate for Payer: Mclaren Commercial |
$5,044.42
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$1,129.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,764.17
|
| Rate for Payer: Nomi Health Commercial |
$4,596.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,203.68
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$2,261.45
|
| Rate for Payer: PHP Medicaid |
$1,101.94
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,911.02
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health Narrow Network |
$3,929.04
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,932.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$3,186.58
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP DNSP |
$2,055.86
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
IP
|
$5,604.91
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,203.68 |
| Max. Negotiated Rate |
$5,604.91 |
| Rate for Payer: Aetna Commercial |
$5,044.42
|
| Rate for Payer: ASR ASR |
$5,436.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,602.75
|
| Rate for Payer: BCN Commercial |
$4,602.75
|
| Rate for Payer: Cash Price |
$4,483.93
|
| Rate for Payer: Cofinity Commercial |
$5,268.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,483.93
|
| Rate for Payer: Healthscope Commercial |
$5,436.76
|
| Rate for Payer: Healthscope Whirlpool |
$5,604.91
|
| Rate for Payer: Mclaren Commercial |
$5,044.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,764.17
|
| Rate for Payer: Nomi Health Commercial |
$4,596.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,203.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,932.32
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
OP
|
$278.14
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
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 |
$194.96
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$155.97
|
| 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 SKIN TAG REMOVAL UP TO 15
|
Facility
|
IP
|
$278.14
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
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 SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: ASR ASR |
$18.53
|
| Rate for Payer: BCBS Trust/PPO |
$15.68
|
| Rate for Payer: BCN Commercial |
$15.68
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Whirlpool |
$19.10
|
| Rate for Payer: Mclaren Commercial |
$17.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.81
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
OP
|
$19.10
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$290.43 |
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: Aetna Medicare |
$7.07
|
| Rate for Payer: ASR ASR |
$18.53
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.75
|
| Rate for Payer: BCN Commercial |
$15.75
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Whirlpool |
$19.10
|
| Rate for Payer: Mclaren Commercial |
$17.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Nomi Health Commercial |
$15.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$290.43
|
| Rate for Payer: Priority Health Narrow Network |
$232.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.81
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$3,228.45 |
| Rate for Payer: Aetna Commercial |
$2,537.98
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: ASR ASR |
$2,735.38
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,325.07
|
| Rate for Payer: BCN Commercial |
$2,325.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,650.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,735.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,819.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$2,537.98
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$1,143.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,470.87
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,976.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,481.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$3,228.45
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,114.99 |
| Max. Negotiated Rate |
$2,819.98 |
| Rate for Payer: Aetna Commercial |
$2,537.98
|
| Rate for Payer: ASR ASR |
$2,735.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,315.77
|
| Rate for Payer: BCN Commercial |
$2,315.77
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,650.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,735.38
|
| Rate for Payer: Healthscope Whirlpool |
$2,819.98
|
| Rate for Payer: Mclaren Commercial |
$2,537.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,481.58
|
|
|
HC SMALLPOX 0.3ML PERQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
63600213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: BCBS MAPPO |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.01
|
| Rate for Payer: Mclaren Medicare |
$0.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.01
|
| Rate for Payer: Meridian Medicaid |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Medicare |
$0.01
|
| Rate for Payer: PACE SWMI |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicaid |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Medicaid |
$0.01
|
| Rate for Payer: UHCCP DNSP |
$0.01
|
| Rate for Payer: UHCCP Medicaid |
$0.01
|
| Rate for Payer: VA VA |
$0.01
|
|
|
HC SMALLPOX 0.3ML PERQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90622
|
| Hospital Charge Code |
63600213
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC SMALLPOX & MONKEYPOX 0.5ML SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.01
|
| Rate for Payer: BCBS MAPPO |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.01
|
| Rate for Payer: Mclaren Medicare |
$0.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.01
|
| Rate for Payer: Meridian Medicaid |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Medicare |
$0.01
|
| Rate for Payer: PACE SWMI |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicaid |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Medicaid |
$0.01
|
| Rate for Payer: UHCCP DNSP |
$0.01
|
| Rate for Payer: UHCCP Medicaid |
$0.01
|
| Rate for Payer: VA VA |
$0.01
|
|
|
HC SMALLPOX & MONKEYPOX 0.5ML SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
63600212
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
|
|
HC SMART NEEDLE
|
Facility
|
OP
|
$510.33
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$188.82 |
| Max. Negotiated Rate |
$510.33 |
| Rate for Payer: Aetna Commercial |
$459.30
|
| Rate for Payer: Aetna Medicare |
$188.82
|
| Rate for Payer: ASR ASR |
$495.02
|
| Rate for Payer: BCBS Complete |
$204.13
|
| Rate for Payer: BCBS Trust/PPO |
$420.77
|
| Rate for Payer: BCN Commercial |
$420.77
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$479.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$495.02
|
| Rate for Payer: Healthscope Whirlpool |
$510.33
|
| Rate for Payer: Mclaren Commercial |
$459.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$418.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$447.15
|
| Rate for Payer: Priority Health Narrow Network |
$357.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.09
|
|
