|
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 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 |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$245.42
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$264.51
|
| Rate for Payer: ASR Commercial |
$264.51
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$223.31
|
| Rate for Payer: BCN Commercial |
$211.42
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| 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 |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$272.69
|
| Rate for Payer: Healthscope Whirlpool |
$264.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$245.42
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.93
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$191.16
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
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 |
$300.37 |
| Rate for Payer: Aetna Commercial |
$132.40
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$142.70
|
| Rate for Payer: ASR Commercial |
$142.70
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$120.47
|
| Rate for Payer: BCN Commercial |
$114.05
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| 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 |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$147.11
|
| Rate for Payer: Healthscope Whirlpool |
$142.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$132.40
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.04
|
| Rate for Payer: Nomi Health Commercial |
$120.63
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.90
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$103.12
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
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 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 |
$103.87 |
| Max. Negotiated Rate |
$556.48 |
| Rate for Payer: Aetna Commercial |
$500.83
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$539.79
|
| Rate for Payer: ASR Commercial |
$539.79
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$455.70
|
| Rate for Payer: BCN Commercial |
$431.44
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| 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 |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$556.48
|
| Rate for Payer: Healthscope Whirlpool |
$539.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$500.83
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$473.01
|
| Rate for Payer: Nomi Health Commercial |
$456.31
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.59
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$390.09
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC SIMULATION - 3D
|
Facility
|
OP
|
$5,248.82
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
33300004
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$715.26 |
| Max. Negotiated Rate |
$5,248.82 |
| Rate for Payer: Aetna Commercial |
$4,723.94
|
| Rate for Payer: Aetna Medicare |
$1,334.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,668.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,668.05
|
| Rate for Payer: ASR ASR |
$5,091.36
|
| Rate for Payer: ASR Commercial |
$5,091.36
|
| Rate for Payer: BCBS Complete |
$751.02
|
| Rate for Payer: BCBS MAPPO |
$1,334.44
|
| Rate for Payer: BCBS Trust/PPO |
$4,298.26
|
| Rate for Payer: BCN Commercial |
$4,069.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,334.44
|
| 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 |
$1,334.44
|
| Rate for Payer: Healthscope Commercial |
$5,248.82
|
| Rate for Payer: Healthscope Whirlpool |
$5,091.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,334.44
|
| Rate for Payer: Mclaren Commercial |
$4,723.94
|
| Rate for Payer: Mclaren Medicaid |
$715.26
|
| Rate for Payer: Mclaren Medicare |
$1,334.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,401.16
|
| Rate for Payer: Meridian Medicaid |
$751.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,534.61
|
| 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 |
$1,267.72
|
| Rate for Payer: PACE SWMI |
$1,334.44
|
| Rate for Payer: PHP Commercial |
$1,467.88
|
| Rate for Payer: PHP Medicaid |
$715.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,334.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.26
|
| 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 |
$1,334.44
|
| Rate for Payer: Priority Health Narrow Network |
$3,679.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1,334.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,618.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,334.44
|
| Rate for Payer: UHC Exchange |
$2,068.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,334.44
|
| Rate for Payer: UHCCP DNSP |
$1,334.44
|
| Rate for Payer: UHCCP Medicaid |
$715.26
|
| Rate for Payer: VA VA |
$1,334.44
|
|
|
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 - 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 |
$191.36 |
| Max. Negotiated Rate |
$1,707.30 |
| Rate for Payer: Aetna Commercial |
$1,536.57
|
| Rate for Payer: Aetna Medicare |
$357.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: ASR ASR |
$1,656.08
|
| Rate for Payer: ASR Commercial |
$1,656.08
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,398.11
|
| Rate for Payer: BCN Commercial |
$1,323.67
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| 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 |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$1,707.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,656.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$1,536.57
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| 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 |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$392.72
|
| Rate for Payer: PHP Medicaid |
$191.36
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| 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 |
$357.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,196.82
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,502.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$553.38
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP DNSP |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC SIMULATION - I
|
Facility
|
OP
|
$1,193.40
|
|
|
Service Code
|
CPT 77285
|
| Hospital Charge Code |
33300060
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Commercial |
$1,074.06
|
| Rate for Payer: Aetna Medicare |
$357.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: ASR ASR |
$1,157.60
|
| Rate for Payer: ASR Commercial |
$1,157.60
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCBS Trust/PPO |
$977.28
|
| Rate for Payer: BCN Commercial |
$925.24
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| 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 |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$1,193.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$357.02
|
| Rate for Payer: Mclaren Commercial |
$1,074.06
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.39
|
| Rate for Payer: Nomi Health Commercial |
$978.59
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$392.72
|
| Rate for Payer: PHP Medicaid |
$191.36
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| 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 |
$357.02
|
| Rate for Payer: Priority Health Narrow Network |
$836.57
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,050.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$553.38
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP DNSP |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$191.36
|
| Rate for Payer: VA VA |
$357.02
|
|
|
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 |
$69.41 |
| Max. Negotiated Rate |
$728.28 |
| Rate for Payer: Aetna Commercial |
$655.45
|
| Rate for Payer: Aetna Medicare |
$129.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.86
|
| Rate for Payer: ASR ASR |
$706.43
|
| Rate for Payer: ASR Commercial |
$706.43
|
| Rate for Payer: BCBS Complete |
$72.88
|
| Rate for Payer: BCBS MAPPO |
$129.49
|
| Rate for Payer: BCBS Trust/PPO |
$596.39
|
| Rate for Payer: BCN Commercial |
$564.64
|
| Rate for Payer: BCN Medicare Advantage |
$129.49
|
| 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 |
$129.49
|
| Rate for Payer: Healthscope Commercial |
$728.28
|
| Rate for Payer: Healthscope Whirlpool |
$706.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$129.49
|
| Rate for Payer: Mclaren Commercial |
$655.45
|
| Rate for Payer: Mclaren Medicaid |
$69.41
|
| Rate for Payer: Mclaren Medicare |
$129.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.96
|
| Rate for Payer: Meridian Medicaid |
$72.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Nomi Health Commercial |
$597.19
|
| Rate for Payer: PACE Medicare |
$123.02
|
| Rate for Payer: PACE SWMI |
$129.49
|
| Rate for Payer: PHP Commercial |
$142.44
|
| Rate for Payer: PHP Medicaid |
$69.41
|
| Rate for Payer: PHP Medicare Advantage |
$129.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.41
|
| 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 |
$129.49
|
| Rate for Payer: Priority Health Narrow Network |
$510.52
|
| Rate for Payer: Railroad Medicare Medicare |
$129.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$640.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.49
|
| Rate for Payer: UHC Exchange |
$200.71
|
| Rate for Payer: UHC Medicare Advantage |
$129.49
|
| Rate for Payer: UHCCP DNSP |
$129.49
|
| Rate for Payer: UHCCP Medicaid |
$69.41
|
| Rate for Payer: VA VA |
$129.49
|
|
|
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
|
|
|
HC SINGLE LEAD INSERTION
|
Facility
|
OP
|
$4,340.87
|
|
|
Service Code
|
CPT 33216
|
| Hospital Charge Code |
36100065
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,821.57 |
| Max. Negotiated Rate |
$12,510.67 |
| Rate for Payer: Aetna Commercial |
$3,906.78
|
| Rate for Payer: Aetna Medicare |
$8,071.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,089.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,089.25
|
| Rate for Payer: ASR ASR |
$4,210.64
|
| Rate for Payer: ASR Commercial |
$4,210.64
|
| Rate for Payer: BCBS Complete |
$4,542.58
|
| Rate for Payer: BCBS MAPPO |
$8,071.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,554.74
|
| Rate for Payer: BCN Commercial |
$3,365.48
|
| Rate for Payer: BCN Medicare Advantage |
$8,071.40
|
| Rate for Payer: Cash Price |
$3,472.70
|
| 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: Health Alliance Plan Medicare Advantage |
$8,071.40
|
| Rate for Payer: Healthscope Commercial |
$4,340.87
|
| Rate for Payer: Healthscope Whirlpool |
$4,210.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,071.40
|
| Rate for Payer: Mclaren Commercial |
$3,906.78
|
| Rate for Payer: Mclaren Medicaid |
$4,326.27
|
| Rate for Payer: Mclaren Medicare |
$8,071.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,474.97
|
| Rate for Payer: Meridian Medicaid |
$4,542.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,282.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,689.74
|
| Rate for Payer: Nomi Health Commercial |
$3,559.51
|
| Rate for Payer: PACE Medicare |
$7,667.83
|
| Rate for Payer: PACE SWMI |
$8,071.40
|
| Rate for Payer: PHP Commercial |
$8,878.54
|
| Rate for Payer: PHP Medicaid |
$4,326.27
|
| Rate for Payer: PHP Medicare Advantage |
$8,071.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,326.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,821.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,803.47
|
| Rate for Payer: Priority Health Medicare |
$8,071.40
|
| Rate for Payer: Priority Health Narrow Network |
$3,042.95
|
| Rate for Payer: Railroad Medicare Medicare |
$8,071.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,819.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,071.40
|
| Rate for Payer: UHC Exchange |
$12,510.67
|
| Rate for Payer: UHC Medicare Advantage |
$8,071.40
|
| Rate for Payer: UHCCP DNSP |
$8,071.40
|
| Rate for Payer: UHCCP Medicaid |
$4,326.27
|
| Rate for Payer: VA VA |
$8,071.40
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
OP
|
$452.01
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$452.01 |
| Rate for Payer: Aetna Commercial |
$406.81
|
| Rate for Payer: Aetna Medicare |
$226.00
|
| Rate for Payer: ASR ASR |
$438.45
|
| Rate for Payer: ASR Commercial |
$438.45
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS Trust/PPO |
$370.15
|
| Rate for Payer: BCN Commercial |
$350.44
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cofinity Commercial |
$424.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.61
|
| Rate for Payer: Healthscope Commercial |
$452.01
|
| Rate for Payer: Healthscope Whirlpool |
$438.45
|
| Rate for Payer: Mclaren Commercial |
$406.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.21
|
| Rate for Payer: Nomi Health Commercial |
$370.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.05
|
| Rate for Payer: Priority Health Narrow Network |
$316.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.77
|
|
|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$452.01
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$452.01 |
| Rate for Payer: Aetna Commercial |
$406.81
|
| Rate for Payer: ASR ASR |
$438.45
|
| Rate for Payer: ASR Commercial |
$438.45
|
| Rate for Payer: BCBS Trust/PPO |
$368.34
|
| Rate for Payer: BCN Commercial |
$350.44
|
| Rate for Payer: Cash Price |
$361.61
|
| Rate for Payer: Cofinity Commercial |
$424.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.61
|
| Rate for Payer: Healthscope Commercial |
$452.01
|
| Rate for Payer: Healthscope Whirlpool |
$438.45
|
| Rate for Payer: Mclaren Commercial |
$406.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.21
|
| Rate for Payer: Nomi Health Commercial |
$370.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.77
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| 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 |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$62.20
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$13.73
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| 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 |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| 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 |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.55
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$53.24
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$21.28
|
| Rate for Payer: UHC Medicare Advantage |
$13.73
|
| Rate for Payer: UHCCP DNSP |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.36
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$75.95 |
| Rate for Payer: Aetna Commercial |
$68.36
|
| Rate for Payer: ASR ASR |
$73.67
|
| Rate for Payer: ASR Commercial |
$73.67
|
| Rate for Payer: BCBS Trust/PPO |
$61.89
|
| Rate for Payer: BCN Commercial |
$58.88
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$71.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$75.95
|
| Rate for Payer: Healthscope Whirlpool |
$73.67
|
| Rate for Payer: Mclaren Commercial |
$68.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.84
|
|
|
HC SITZ MARKER
|
Facility
|
IP
|
$85.68
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: ASR ASR |
$83.11
|
| Rate for Payer: ASR Commercial |
$83.11
|
| Rate for Payer: BCBS Trust/PPO |
$69.82
|
| Rate for Payer: BCN Commercial |
$66.43
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Healthscope Whirlpool |
$83.11
|
| Rate for Payer: Mclaren Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: Nomi Health Commercial |
$70.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.40
|
|
|
HC SITZ MARKER
|
Facility
|
OP
|
$85.68
|
|
|
Service Code
|
CPT A9698
|
| Hospital Charge Code |
25500004
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: ASR ASR |
$83.11
|
| Rate for Payer: ASR Commercial |
$83.11
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: BCBS Trust/PPO |
$70.16
|
| Rate for Payer: BCN Commercial |
$66.43
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Healthscope Whirlpool |
$83.11
|
| Rate for Payer: Mclaren Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: Nomi Health Commercial |
$70.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.07
|
| Rate for Payer: Priority Health Narrow Network |
$60.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.40
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
OP
|
$5,495.01
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,495.01 |
| Rate for Payer: Aetna Commercial |
$4,945.51
|
| Rate for Payer: Aetna Medicare |
$1,784.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: ASR ASR |
$5,330.16
|
| Rate for Payer: ASR Commercial |
$5,330.16
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCBS Trust/PPO |
$4,499.86
|
| Rate for Payer: BCN Commercial |
$4,260.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cofinity Commercial |
$5,165.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,396.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$5,495.01
|
| Rate for Payer: Healthscope Whirlpool |
$5,330.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,784.01
|
| Rate for Payer: Mclaren Commercial |
$4,945.51
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,670.76
|
| Rate for Payer: Nomi Health Commercial |
$4,505.91
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,962.41
|
| Rate for Payer: PHP Medicaid |
$956.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,571.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,814.73
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health Narrow Network |
$3,852.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,835.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$2,765.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP DNSP |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
IP
|
$5,495.01
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,571.76 |
| Max. Negotiated Rate |
$5,495.01 |
| Rate for Payer: Aetna Commercial |
$4,945.51
|
| Rate for Payer: ASR ASR |
$5,330.16
|
| Rate for Payer: ASR Commercial |
$5,330.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,477.88
|
| Rate for Payer: BCN Commercial |
$4,260.28
|
| Rate for Payer: Cash Price |
$4,396.01
|
| Rate for Payer: Cofinity Commercial |
$5,165.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,396.01
|
| Rate for Payer: Healthscope Commercial |
$5,495.01
|
| Rate for Payer: Healthscope Whirlpool |
$5,330.16
|
| Rate for Payer: Mclaren Commercial |
$4,945.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,670.76
|
| Rate for Payer: Nomi Health Commercial |
$4,505.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,571.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,835.61
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
OP
|
$272.69
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$300.37 |
| Rate for Payer: Aetna Commercial |
$245.42
|
| Rate for Payer: Aetna Medicare |
$193.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: ASR ASR |
$264.51
|
| Rate for Payer: ASR Commercial |
$264.51
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCBS Trust/PPO |
$223.31
|
| Rate for Payer: BCN Commercial |
$211.42
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| 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 |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$272.69
|
| Rate for Payer: Healthscope Whirlpool |
$264.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$193.79
|
| Rate for Payer: Mclaren Commercial |
$245.42
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.79
|
| Rate for Payer: Nomi Health Commercial |
$223.61
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$213.17
|
| Rate for Payer: PHP Medicaid |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.93
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health Narrow Network |
$191.16
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$300.37
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP DNSP |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
