APC 05613
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC 3D TX PLAN INCL SIMDVH
Low
$819
Average
$1.8k
Median
$1.8k
High
$3.4k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
8 hospitals; the 90th percentile is 2.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
8 hospital rates
iThe hospitals that file a Molina rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 2 | Good Samaritan Hospital Suffern, NY facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 3 | HSA CGH LLC Coral Gables, FL facility · fee schedule · outpatient | 2 | $1.8k | $1.8k | $317 | 18% | — | $1.5k – $2.1k |
| 4 | HSA PGH LLC Hialeah, FL facility · fee schedule · outpatient | 2 | $3.4k | $3.4k | $1.3k | 38% | — | $2.1k – $4.6k |
| 5 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 2 | $1.8k | $1.8k | $33 | 2% | — | $1.8k – $1.8k |
| 6 | Memorial Hospital Fremont, OH facility · fee schedule · outpatient | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 7 | Mercy Memorial Hospital Corporation Monroe, MI facility · other · outpatient | 1 | $819 | $819 | — | — | — | $819 – $819 |
| 8 | St Anthony Community Hospital Warwick, NY facility · fee schedule · outpatient | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
← Payers reporting APC 05613 · Snapshot 20261111T120946Z-9134e7f7