|
HC SILVER ROPE
|
Facility
|
OP
|
$54.58
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: Aetna Commercial |
$49.12
|
| Rate for Payer: Aetna Medicare |
$27.29
|
| Rate for Payer: ASR ASR |
$52.94
|
| Rate for Payer: ASR Commercial |
$52.94
|
| Rate for Payer: BCBS Complete |
$21.83
|
| Rate for Payer: BCBS Trust/PPO |
$44.70
|
| Rate for Payer: BCN Commercial |
$42.32
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$51.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Healthscope Commercial |
$54.58
|
| Rate for Payer: Healthscope Whirlpool |
$52.94
|
| Rate for Payer: Mclaren Commercial |
$49.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: Nomi Health Commercial |
$44.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.82
|
| Rate for Payer: Priority Health Narrow Network |
$38.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.03
|
|
|
HC SILVER ROPE
|
Facility
|
IP
|
$54.58
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: Aetna Commercial |
$49.12
|
| Rate for Payer: ASR ASR |
$52.94
|
| Rate for Payer: ASR Commercial |
$52.94
|
| Rate for Payer: BCBS Trust/PPO |
$44.48
|
| Rate for Payer: BCN Commercial |
$42.32
|
| Rate for Payer: Cash Price |
$43.66
|
| Rate for Payer: Cofinity Commercial |
$51.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.66
|
| Rate for Payer: Healthscope Commercial |
$54.58
|
| Rate for Payer: Healthscope Whirlpool |
$52.94
|
| Rate for Payer: Mclaren Commercial |
$49.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.39
|
| Rate for Payer: Nomi Health Commercial |
$44.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.03
|
|
|
HC SIMIAN B AB
|
Facility
|
OP
|
$91.09
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$91.09 |
| Rate for Payer: Aetna Commercial |
$81.98
|
| 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 |
$88.36
|
| Rate for Payer: ASR Commercial |
$88.36
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$74.59
|
| Rate for Payer: BCN Commercial |
$70.62
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$72.87
|
| Rate for Payer: Cash Price |
$72.87
|
| Rate for Payer: Cofinity Commercial |
$85.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$91.09
|
| Rate for Payer: Healthscope Whirlpool |
$88.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$81.98
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| 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 |
$7.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.43
|
| Rate for Payer: Nomi Health Commercial |
$74.69
|
| 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 |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.81
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow Network |
$63.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: UHCCP DNSP |
$12.88
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC SIMIAN B AB
|
Facility
|
IP
|
$91.09
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.21 |
| Max. Negotiated Rate |
$91.09 |
| Rate for Payer: Aetna Commercial |
$81.98
|
| Rate for Payer: ASR ASR |
$88.36
|
| Rate for Payer: ASR Commercial |
$88.36
|
| Rate for Payer: BCBS Trust/PPO |
$74.23
|
| Rate for Payer: BCN Commercial |
$70.62
|
| Rate for Payer: Cash Price |
$72.87
|
| Rate for Payer: Cofinity Commercial |
$85.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.87
|
| Rate for Payer: Healthscope Commercial |
$91.09
|
| Rate for Payer: Healthscope Whirlpool |
$88.36
|
| Rate for Payer: Mclaren Commercial |
$81.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.43
|
| Rate for Payer: Nomi Health Commercial |
$74.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.16
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$361.15
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.72 |
| Max. Negotiated Rate |
$369.35 |
| Rate for Payer: Aetna Commercial |
$325.04
|
| Rate for Payer: Aetna Medicare |
$238.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: ASR ASR |
$350.32
|
| Rate for Payer: ASR Commercial |
$350.32
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$295.75
|
| Rate for Payer: BCN Commercial |
$280.00
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$339.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$361.15
|
| Rate for Payer: Healthscope Whirlpool |
$350.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$238.29
|
| Rate for Payer: Mclaren Commercial |
$325.04
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$296.14
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$262.12
|
| Rate for Payer: PHP Medicaid |
$127.72
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.44
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$253.17
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$369.35
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP DNSP |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: VA VA |
$238.29
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$361.15
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.75 |
| Max. Negotiated Rate |
$361.15 |
| Rate for Payer: Aetna Commercial |
$325.04
|
| Rate for Payer: ASR ASR |
$350.32
|
| Rate for Payer: ASR Commercial |
$350.32
|
| Rate for Payer: BCBS Trust/PPO |
$294.30
|
| Rate for Payer: BCN Commercial |
$280.00
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$339.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Healthscope Commercial |
$361.15
|
| Rate for Payer: Healthscope Whirlpool |
$350.32
|
| Rate for Payer: Mclaren Commercial |
$325.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$296.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$317.81
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$562.00 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: ASR ASR |
$545.14
|
| Rate for Payer: ASR Commercial |
$545.14
|
| Rate for Payer: BCBS Trust/PPO |
$457.97
|
| Rate for Payer: BCN Commercial |
$435.72
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$528.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.60
|
| Rate for Payer: Healthscope Commercial |
$562.00
|
| Rate for Payer: Healthscope Whirlpool |
$545.14
|
| Rate for Payer: Mclaren Commercial |
$505.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.70
|
| Rate for Payer: Nomi Health Commercial |
$460.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.56
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 2.6 CM-5.0 CM
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$562.00 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$545.14
|
| Rate for Payer: ASR Commercial |
$545.14
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$460.22
|
| Rate for Payer: BCN Commercial |
$435.72
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$528.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$562.00
|
| Rate for Payer: Healthscope Whirlpool |
$545.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$505.80
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.70
|
| Rate for Payer: Nomi Health Commercial |
$460.84
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Aetna Commercial |
$574.20
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$618.86
|
| Rate for Payer: ASR Commercial |
$618.86
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$522.46
|
| Rate for Payer: BCN Commercial |
$494.64
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$599.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$638.00
|
| Rate for Payer: Healthscope Whirlpool |
$618.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$574.20
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.30
|
| Rate for Payer: Nomi Health Commercial |
$523.16
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$561.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC SIMPLE REPAIR FACE EARS EYELIDS NOSE LIP OR MUC MEMB 5.1CM-7.5 CM
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
76100433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.70 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Aetna Commercial |
$574.20
|
| Rate for Payer: ASR ASR |
$618.86
|
| Rate for Payer: ASR Commercial |
$618.86
|
| Rate for Payer: BCBS Trust/PPO |
$519.91
|
| Rate for Payer: BCN Commercial |
$494.64
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$599.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$510.40
|
| Rate for Payer: Healthscope Commercial |
$638.00
|
| Rate for Payer: Healthscope Whirlpool |
$618.86
|
| Rate for Payer: Mclaren Commercial |
$574.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$542.30
|
| Rate for Payer: Nomi Health Commercial |
$523.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$561.44
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
OP
|
$272.69
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$245.42
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$264.51
|
| Rate for Payer: ASR Commercial |
$264.51
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$223.31
|
| Rate for Payer: BCN Commercial |
$211.42
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$256.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$272.69
|
| Rate for Payer: Healthscope Whirlpool |
$264.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$245.42
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC SIMPLE REP WD FACE,EAR,EYELID,NOSE,LIP,MUC MEMB 2.5CM OR LESS
|
Facility
|
IP
|
$272.69
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
76100274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.25 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$245.42
|
| Rate for Payer: ASR ASR |
$264.51
|
| Rate for Payer: ASR Commercial |
$264.51
|
| Rate for Payer: BCBS Trust/PPO |
$222.22
|
| Rate for Payer: BCN Commercial |
$211.42
|
| Rate for Payer: Cash Price |
$218.15
|
| Rate for Payer: Cofinity Commercial |
$256.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.15
|
| Rate for Payer: Healthscope Commercial |
$272.69
|
| Rate for Payer: Healthscope Whirlpool |
$264.51
|
| Rate for Payer: Mclaren Commercial |
$245.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.97
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
IP
|
$147.11
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$147.11 |
| Rate for Payer: Aetna Commercial |
$132.40
|
| Rate for Payer: ASR ASR |
$142.70
|
| Rate for Payer: ASR Commercial |
$142.70
|
| Rate for Payer: BCBS Trust/PPO |
$119.88
|
| Rate for Payer: BCN Commercial |
$114.05
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$138.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Healthscope Commercial |
$147.11
|
| Rate for Payer: Healthscope Whirlpool |
$142.70
|
| Rate for Payer: Mclaren Commercial |
$132.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.46
|
|
|
HC SIMPLE REP WD SCALP,NECK,AXILLAE,GENITALIA,TRUNK, EXTREMS 2.6 TO 7.5 CM
|
Facility
|
OP
|
$147.11
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Aetna Commercial |
$132.40
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$142.70
|
| Rate for Payer: ASR Commercial |
$142.70
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$120.47
|
| Rate for Payer: BCN Commercial |
$114.05
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cash Price |
$117.69
|
| Rate for Payer: Cofinity Commercial |
$138.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$147.11
|
| Rate for Payer: Healthscope Whirlpool |
$142.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$132.40
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
OP
|
$556.48
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.35 |
| Max. Negotiated Rate |
$556.48 |
| Rate for Payer: Aetna Commercial |
$500.83
|
| Rate for Payer: Aetna Medicare |
$194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: ASR ASR |
$539.79
|
| Rate for Payer: ASR Commercial |
$539.79
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$455.70
|
| Rate for Payer: BCN Commercial |
$431.44
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cofinity Commercial |
$523.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Healthscope Commercial |
$556.48
|
| Rate for Payer: Healthscope Whirlpool |
$539.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$194.68
|
| Rate for Payer: Mclaren Commercial |
$500.83
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.01
|
| Rate for Payer: Nomi Health Commercial |
$456.31
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Commercial |
$214.15
|
| Rate for Payer: PHP Medicaid |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.98
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$212.78
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$301.75
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP DNSP |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$104.35
|
| Rate for Payer: VA VA |
$194.68
|
|
|
HC SIMPLE REP WD SCALPNECKAXILLAEGENITALIIATRUNK EXTREMS 7.6 TO 12.5 CM
|
Facility
|
IP
|
$556.48
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
76100437
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.71 |
| Max. Negotiated Rate |
$556.48 |
| Rate for Payer: Aetna Commercial |
$500.83
|
| Rate for Payer: ASR ASR |
$539.79
|
| Rate for Payer: ASR Commercial |
$539.79
|
| Rate for Payer: BCBS Trust/PPO |
$453.48
|
| Rate for Payer: BCN Commercial |
$431.44
|
| Rate for Payer: Cash Price |
$445.18
|
| Rate for Payer: Cofinity Commercial |
$523.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$445.18
|
| Rate for Payer: Healthscope Commercial |
$556.48
|
| Rate for Payer: Healthscope Whirlpool |
$539.79
|
| Rate for Payer: Mclaren Commercial |
$500.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.01
|
| Rate for Payer: Nomi Health Commercial |
$456.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.70
|
|
|
HC SIMULATION - 3D
|
Facility
|
IP
|
$5,248.82
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$3,411.73 |
| Max. Negotiated Rate |
$5,248.82 |
| Rate for Payer: Aetna Commercial |
$4,723.94
|
| Rate for Payer: ASR ASR |
$5,091.36
|
| Rate for Payer: ASR Commercial |
$5,091.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,277.26
|
| Rate for Payer: BCN Commercial |
$4,069.41
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cofinity Commercial |
$4,933.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,199.06
|
| Rate for Payer: Healthscope Commercial |
$5,248.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,091.36
|
| Rate for Payer: Mclaren Commercial |
$4,723.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,461.50
|
| Rate for Payer: Nomi Health Commercial |
$4,304.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,618.96
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,248.82
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$718.56 |
| Max. Negotiated Rate |
$5,248.82 |
| Rate for Payer: Aetna Commercial |
$4,723.94
|
| Rate for Payer: Aetna Medicare |
$1,340.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,675.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,675.74
|
| Rate for Payer: ASR ASR |
$5,091.36
|
| Rate for Payer: ASR Commercial |
$5,091.36
|
| Rate for Payer: BCBS Complete |
$754.48
|
| Rate for Payer: BCBS MAPPO |
$1,340.59
|
| Rate for Payer: BCBS Trust/PPO |
$4,298.26
|
| Rate for Payer: BCN Commercial |
$4,069.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,340.59
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cash Price |
$4,199.06
|
| Rate for Payer: Cofinity Commercial |
$4,933.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,199.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,340.59
|
| Rate for Payer: Healthscope Commercial |
$5,248.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,091.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,340.59
|
| Rate for Payer: Mclaren Commercial |
$4,723.94
|
| Rate for Payer: Mclaren Medicaid |
$718.56
|
| Rate for Payer: Mclaren Medicare |
$1,340.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,407.62
|
| Rate for Payer: Meridian Medicaid |
$754.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,541.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,461.50
|
| Rate for Payer: Nomi Health Commercial |
$4,304.03
|
| Rate for Payer: PACE Medicare |
$1,273.56
|
| Rate for Payer: PACE SWMI |
$1,340.59
|
| Rate for Payer: PHP Commercial |
$1,474.65
|
| Rate for Payer: PHP Medicaid |
$718.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,340.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,411.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,599.02
|
| Rate for Payer: Priority Health Medicare |
$1,340.59
|
| Rate for Payer: Priority Health Narrow Network |
$3,679.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,340.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,618.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,340.59
|
| Rate for Payer: UHC Exchange |
$2,077.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,340.59
|
| Rate for Payer: UHCCP DNSP |
$1,340.59
|
| Rate for Payer: UHCCP Medicaid |
$718.56
|
| Rate for Payer: VA VA |
$1,340.59
|
|
|
HC SIMULATION - C
|
Facility
|
IP
|
$1,707.30
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,109.74 |
| Max. Negotiated Rate |
$1,707.30 |
| Rate for Payer: Aetna Commercial |
$1,536.57
|
| Rate for Payer: ASR ASR |
$1,656.08
|
| Rate for Payer: ASR Commercial |
$1,656.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,391.28
|
| Rate for Payer: BCN Commercial |
$1,323.67
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cofinity Commercial |
$1,604.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,365.84
|
| Rate for Payer: Healthscope Commercial |
$1,707.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,656.08
|
| Rate for Payer: Mclaren Commercial |
$1,536.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,451.20
|
| Rate for Payer: Nomi Health Commercial |
$1,399.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,109.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,502.42
|
|
|
HC SIMULATION - C
|
Facility
|
OP
|
$1,707.30
|
|
|
Service Code
|
CPT 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$192.25 |
| Max. Negotiated Rate |
$1,707.30 |
| Rate for Payer: Aetna Commercial |
$1,536.57
|
| Rate for Payer: Aetna Medicare |
$358.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$448.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$448.34
|
| Rate for Payer: ASR ASR |
$1,656.08
|
| Rate for Payer: ASR Commercial |
$1,656.08
|
| Rate for Payer: BCBS Complete |
$201.86
|
| Rate for Payer: BCBS MAPPO |
$358.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,398.11
|
| Rate for Payer: BCN Commercial |
$1,323.67
|
| Rate for Payer: BCN Medicare Advantage |
$358.67
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cash Price |
$1,365.84
|
| Rate for Payer: Cofinity Commercial |
$1,604.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,365.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$358.67
|
| Rate for Payer: Healthscope Commercial |
$1,707.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,656.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$358.67
|
| Rate for Payer: Mclaren Commercial |
$1,536.57
|
| Rate for Payer: Mclaren Medicaid |
$192.25
|
| Rate for Payer: Mclaren Medicare |
$358.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$376.60
|
| Rate for Payer: Meridian Medicaid |
$201.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$412.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,451.20
|
| Rate for Payer: Nomi Health Commercial |
$1,399.99
|
| Rate for Payer: PACE Medicare |
$340.74
|
| Rate for Payer: PACE SWMI |
$358.67
|
| Rate for Payer: PHP Commercial |
$394.54
|
| Rate for Payer: PHP Medicaid |
$192.25
|
| Rate for Payer: PHP Medicare Advantage |
$358.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,109.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,495.94
|
| Rate for Payer: Priority Health Medicare |
$358.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,196.82
|
| Rate for Payer: Railroad Medicare Medicare |
$358.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,502.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$358.67
|
| Rate for Payer: UHC Exchange |
$555.94
|
| Rate for Payer: UHC Medicare Advantage |
$358.67
|
| Rate for Payer: UHCCP DNSP |
$358.67
|
| Rate for Payer: UHCCP Medicaid |
$192.25
|
| Rate for Payer: VA VA |
$358.67
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$1,193.40
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$192.25 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Commercial |
$1,074.06
|
| Rate for Payer: Aetna Medicare |
$358.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$448.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$448.34
|
| Rate for Payer: ASR ASR |
$1,157.60
|
| Rate for Payer: ASR Commercial |
$1,157.60
|
| Rate for Payer: BCBS Complete |
$201.86
|
| Rate for Payer: BCBS MAPPO |
$358.67
|
| Rate for Payer: BCBS Trust/PPO |
$977.28
|
| Rate for Payer: BCN Commercial |
$925.24
|
| Rate for Payer: BCN Medicare Advantage |
$358.67
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cofinity Commercial |
$1,121.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$358.67
|
| Rate for Payer: Healthscope Commercial |
$1,193.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$358.67
|
| Rate for Payer: Mclaren Commercial |
$1,074.06
|
| Rate for Payer: Mclaren Medicaid |
$192.25
|
| Rate for Payer: Mclaren Medicare |
$358.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$376.60
|
| Rate for Payer: Meridian Medicaid |
$201.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$412.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.39
|
| Rate for Payer: Nomi Health Commercial |
$978.59
|
| Rate for Payer: PACE Medicare |
$340.74
|
| Rate for Payer: PACE SWMI |
$358.67
|
| Rate for Payer: PHP Commercial |
$394.54
|
| Rate for Payer: PHP Medicaid |
$192.25
|
| Rate for Payer: PHP Medicare Advantage |
$358.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,045.66
|
| Rate for Payer: Priority Health Medicare |
$358.67
|
| Rate for Payer: Priority Health Narrow Network |
$836.57
|
| Rate for Payer: Railroad Medicare Medicare |
$358.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,050.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$358.67
|
| Rate for Payer: UHC Exchange |
$555.94
|
| Rate for Payer: UHC Medicare Advantage |
$358.67
|
| Rate for Payer: UHCCP DNSP |
$358.67
|
| Rate for Payer: UHCCP Medicaid |
$192.25
|
| Rate for Payer: VA VA |
$358.67
|
|
|
HC SIMULATION - I
|
Facility
|
IP
|
$1,193.40
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$775.71 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Commercial |
$1,074.06
|
| Rate for Payer: ASR ASR |
$1,157.60
|
| Rate for Payer: ASR Commercial |
$1,157.60
|
| Rate for Payer: BCBS Trust/PPO |
$972.50
|
| Rate for Payer: BCN Commercial |
$925.24
|
| Rate for Payer: Cash Price |
$954.72
|
| Rate for Payer: Cofinity Commercial |
$1,121.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.72
|
| Rate for Payer: Healthscope Commercial |
$1,193.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.60
|
| Rate for Payer: Mclaren Commercial |
$1,074.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.39
|
| Rate for Payer: Nomi Health Commercial |
$978.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,050.19
|
|
|
HC SIMULATION - S
|
Facility
|
OP
|
$728.28
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$728.28 |
| Rate for Payer: Aetna Commercial |
$655.45
|
| Rate for Payer: Aetna Medicare |
$130.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: ASR ASR |
$706.43
|
| Rate for Payer: ASR Commercial |
$706.43
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$596.39
|
| Rate for Payer: BCN Commercial |
$564.64
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$684.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$728.28
|
| Rate for Payer: Healthscope Whirlpool |
$706.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$130.09
|
| Rate for Payer: Mclaren Commercial |
$655.45
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Nomi Health Commercial |
$597.19
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$143.10
|
| Rate for Payer: PHP Medicaid |
$69.73
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$638.12
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$510.52
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$640.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$201.64
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP DNSP |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$69.73
|
| Rate for Payer: VA VA |
$130.09
|
|
|
HC SIMULATION - S
|
Facility
|
IP
|
$728.28
|
|
|
Service Code
|
CPT 77280
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$473.38 |
| Max. Negotiated Rate |
$728.28 |
| Rate for Payer: Aetna Commercial |
$655.45
|
| Rate for Payer: ASR ASR |
$706.43
|
| Rate for Payer: ASR Commercial |
$706.43
|
| Rate for Payer: BCBS Trust/PPO |
$593.48
|
| Rate for Payer: BCN Commercial |
$564.64
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$684.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Healthscope Commercial |
$728.28
|
| Rate for Payer: Healthscope Whirlpool |
$706.43
|
| Rate for Payer: Mclaren Commercial |
$655.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Nomi Health Commercial |
$597.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$640.89
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
IP
|
$4,340.87
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,821.57 |
| Max. Negotiated Rate |
$4,340.87 |
| Rate for Payer: Aetna Commercial |
$3,906.78
|
| Rate for Payer: ASR ASR |
$4,210.64
|
| Rate for Payer: ASR Commercial |
$4,210.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,537.37
|
| Rate for Payer: BCN Commercial |
$3,365.48
|
| Rate for Payer: Cash Price |
$3,472.70
|
| Rate for Payer: Cofinity Commercial |
$4,080.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,472.70
|
| Rate for Payer: Healthscope Commercial |
$4,340.87
|
| Rate for Payer: Healthscope Whirlpool |
$4,210.64
|
| Rate for Payer: Mclaren Commercial |
$3,906.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,689.74
|
| Rate for Payer: Nomi Health Commercial |
$3,559.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,821.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,819.97
|
|
